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OMB APPROVAL
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- ------ OMB Number: 3236-0287
FORM 4 Expires: February 1, 1994
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hours per response .... 0.5
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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
/ / Check this box if no
longer subject to Filed pursuant to Section 16(a) of the Securities
Section 16. Form 4 Exchange Act of 1934, Section 17(a) of the
or Form 5 obligations Public Utility Holding Company Act of 1935
may continue. See or Section 30(f) of the Investment Company
Instruction 1(b). Act of 1940
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<S> <C> <C> <C> <C> <C> <C>
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1. Name and Address of Reporting Person 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to
Clemens Peter A. HALSEY DRUG CO., INC. (HDG) Issuer (Check all applicable)
- ------------------------------------------- -------------------------------------------- Director 10% Owner
(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- ---
c/o Halsey Drug Co., Inc. Number of Reporting Month/Year X Officer (give Other (Specify
1827 Pacific Street Person (Voluntary) 3/98 ---- title --- below)
- --------------------------------------------- ###-##-#### ------------------- below)
(Street) -------------------- 5. If Amendment, Vice President and
Brooklyn, New York 11233 Date of Original Chief Financial Officer
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(City) (State) (Zip) 7. 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 1 -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature
(Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In-
Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct
(Instr. 8) End of Month Direct Benefi-
(Month/ (Instr. 3 and 4) (D) or cial
Day/ --------------------------------------- Indirect Owner-
Year) Code V Amount (A) or Price (I) ship
(D) (Instr. 4) (Instr.
4)
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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) SEC 1474 (3/91)
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FORM 4 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
<S> <C> <C> <C> <C> <C> <C> <C>
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1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price
Security sion or action action Derivative cisable and of Underlying of
(Instr. 3) Exercise Date Code Securities Ac- Expiration Securities Deriv-
Price of (Month/ (Instr. 8) quired (A) or Date (Instr. 3 and 4) ative
Deriv- Day/ Disposed of (D) (Month/Day/ Secur-
ative Year) (Instr. 3, 4, Year) ity
Security and 5) (Instr. 5)
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Date Expira- Amount or
-------------------------- Exer- tion Title Number of
Code V (A) (D) cisable Date Shares
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Convertible Debenture 3/10/98 A * 3/10/98 3/10/03 Common Stock 66,667
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Stock Purchase Warrants 3/10/98 A * 3/10/98 3/10/05 Common Stock 10,101
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Stock Purchase Warrants 3/10/98 A * 3/10/98 3/10/05 Common Stock 10,101
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<S> <C> <C> <C>
1. Title of Derivative 9. Number of 10. Ownership 11. Nature of
Security Derivative Form of Indirect
(Instr. 3) Securities Derivative Beneficial
Beneficially Security: Ownership
Owned at End Direct (D) (Instr. 4)
of Month or Indirect (I)
(Instr. 4) (Instr. 4)
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Convertible Debenture 66,667 Direct
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Stock Purchase Warrants 10,101 Direct
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Stock Purchase Warrants 10,101 Direct
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Explanation of Responses:
* Purchased in connection with a private offering on March 10, 1998 consisting of a Convertible
Debenture convertible at any time and Stock Purchase Warrants (10,101 shares of which are presently
exercisable at $1.50 per share and 10,101 shares of which are presently exercisable at $2.38 per share).
** Intentional misstatements or omission of facts constitute Federal Criminal by: /s/ Peter A. Clemens 4/7/98
Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ------------------------------- ------
*Signature of Reporting Person Date
Note. File three copies of this Form, one of which must be manually signed. Page 2
If space provided is insufficient, see Instruction 6 for procedure. SEC 1474 (3/91)
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