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OMB APPROVAL
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OMB Number 3235-0287
Expires: February 1, 2000
Estimated average burden:0.5 hours
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U.S. 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(f) of the Investment Company Act of 1940
[_] Check box if no longer subject of 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*
HEITMEYER STEPHANIE K.
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(Last) (First) (Middle)
c/o Halsey Drug Co. 17759 State Route 66
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(Street)
Ft. Jennings Ohio 45844
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
HALSEY DRUG CO., INC. Symbol:HDG
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3. IRS or Social Security Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
7/99
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
[_] Director [_] 10% Owner
[x] Officer (give title below) [_] Other (specify below)
Vice-President (Sales)
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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 I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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<TABLE>
<CAPTION>
6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
3. Disposed of (D) Securities Form: 7.
2. Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of
Transaction Code ------------------------------- Owned at End (D) or Indirect
1. Date (Instr. 8) (A) of Month Indirect Beneficial
Title of Security (Month/ ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) Day/Year) Code V (D) and 4) (Instr.4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Common Stock 7/1/99 P 274 A $1.1312
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Common Stock 7/1/99 P 127 A $2.4250 401 D
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
* If this Form is filed by more than one Person, see
Instruction 4(b)(v).
(Over)
(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)
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<TABLE>
<CAPTION>
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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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
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5% Convertible Common
Senior Secured $1.404 3/10/98 A (1) 3/10/98 3/15/03 Stock 14,245 14,245 D
Debentures
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Common
Warrants $1.404 3/10/98 A (1) 3/10/98 3/15/05 Stock 2,020 2,020 D
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Common
Warrants $2.279 3/10/98 A (1) 3/10/98 3/15/05 Stock 2,020 2,020 D
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5% Convertible Common
Senior Secured $1.404 6/12/98 A4 (2) 6/12/98 3/15/03 Stock 3,424 3,424 D
Debentures
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Common
Warrants $1.404 6/12/98 A4 (2) 6/12/98 3/15/05 Stock 485 485 D
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Common
Warrants $2.279 6/12/98 A4 (2) 6/12/98 3/15/05 Stock 485 485 D
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Qualified Common
Stock Options $2.50 5/29/98 A4 (3) 5/29/08 Stock 40,000 40,000 D
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</TABLE>
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 (2,020 shares of which are presently exercisable at $1.404 per share
and 2,020 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 (485 shares of which are presently exercisable
at $1.404 per share and 485 shares of which are presently exercisable at $2.279
per share); and (iii) certain interest payments payable quarterly which are paid
in the form of shares of common stock of the Issuer (See Table I).
(3) Options vest annually, with 10,000 options vesting every quarter
effective 5/1/99.
/s/ Stephanie K. Heitmeyer August 9 , 1999
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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 provided is insufficient, see Instruction 6 for procedure. 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 OMB
Number.
