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FORM 4
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OMB APPROVAL
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OMB Number 2236-0287
Expires: February 1, 2000
Estimated average burden:
0.5 hours
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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
/ / Check 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
Smith Alan J. Halsey Drug Co., Inc. Symbol: HDG Issuer
- ------------------------------------------- -------------------------------------------- X Director 10% Owner
(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- ---
c/o Halsey Drug Co. Number of Reporting Month/Year Officer (give Other (Specify
695 N. Perryville Rd. Bldg. 2 Person (Voluntary) 2/99 ---- title --- below)
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(Street) -------------------- 5. If Amendment, __________________________________
Rockford Illinois 61107 Date of Original 7. Individual or Group Filing
- --------------------------------------------- (Month/Year) (Check Applicable Line)
(City) (State) (Zip) X Form filed by One Reporting Person
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__ 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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Common Stock 4,600 D
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (over)
* If the Form is filed by more than one person, see Instruction 4(b)(v). SFC 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 Debentures (1) 3/10/98 3/10/03 Common 6,667
Stock
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Stock Purchase Warrants (1) 3/10/98 3/10/05 Common 1,010
Stock
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Stock Purchase Warrants (1) 3/10/98 3/10/05 Common 1,010
Stock
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5% Convertible Senior $1.50 6/15/98 A4 (2) 6/15/98 ** Common 1,602.66
Secured Notes Stock
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Warrant $1.50 6/15/98 A4 (2) 6/15/98 6/15/05 Common 243
Stock
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Warrant $2.375 6/15/98 A4 (3) 6/15/98 6/15/05 Common 243
Stock
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10% Convertible Senior $1.3313 12/7/98 A4 (3) 12/7/98 * Common 6,009
Secured Notes Stock
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Warrants $1.3313 12/7/98 A4 (3) 12/7/98 12/7/05 Common 800
Stock
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Non-qualified $1.225 2/18/99 A 10,000 (4) 12/19/09 Common 10,000
stock option Stock
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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 Debentures 6,667 D
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Stock Purchase Warrants 1,010 D
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Stock Purchase Warrants 1,010 D
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5% Convertible Senior
Secured Notes 1,602.66 D
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Warrant 243 D
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Warrant 243 D
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10% Convertible Senior 6,009 D
Secured Notes
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Warrants 800 D
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Non-qualified 20,000 D
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Explanations:
(1) Acquired in connection with a private offering on 3/10/98 consisting of a Convertible Debenture exercisable at any time and
Warrants to purchase shares of common stock (1,010 shares of which are presently exercisable at $1.50 per share and 1,010
shares of which are presently exercisable at $2.38 per share).
(2) Acquired pursuant to an option exercise in June 1998, consisting of: (i) a Convertible Debenture exercisable at any time; and
(ii) Warrants to purchase shares of common stock (243 shares of which are presently exercisable at $1.50 per share, and 243
shares of which are presently exercisable at $2.375 per share).
(3) Acquired in connection with a loan in principal amount of $8,000 made pursuant to the First Amendment to the Amended, Restated
and Consolidated Bridge Loan Agreement dated as of December 7, 1998 consisting of: (i) a 10% Convertible Senior Secured Note;
and (ii) Warrants to purchase common stock which are presently exercisable at $1.3313 per share.
(4) Options vest over twelve (12) months: 2,500 on 5/18/99; 2,500 on 8/18/99; 2,500 on 11/18/99 and final 2,500 options on 2/18/00.
* Payable on May 30, 19999 to the Holder (Alan Smith).
** Payable on March 15, 2003 to the Holder (Alan Smith).
Intentional misstatements or omissions of facts constitute Federal /s/ Alan J. Smith March 9, 1999
Criminal 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. (Bulletin No. 177, 10-15-97)
Potential persons who are to respond to the collection of information contained
in this form are not required to respond unless the form displays a currently
valid QMB Number.
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