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- ------ OMB Number 3235-0287
FORM 4 Expires: February 1, 2000
- ------ Estimated average burden:
0.5 hours
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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 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(1) 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
Skelly William G. Halsey Drug Co., Inc. Symbol: HDG Issuer
- ------------------------------------------- -------------------------------------------- X Director 10% Owner
(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- ---
Number of Reporting Month/Year Officer (give X Other (Specify
c/o Halsey Drug Co. 695 N. Perryville Bldg. 2 Person (Voluntary) 2/99 ---- title --- below)
- --------------------------------------------- ------------------- below)
(Street) -------------------- 5. If Amendment, Chairman
Rockford Illinois 61107 Date of Original ------------------------------------
- --------------------------------------------- (Month/Year) 7. Individual or Group Filing
(City) (State) (Zip) (Check Applicable Line)
------------ 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 4/29/98 P4 10,000 A $2.85 10,000 D
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
*If this 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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Non-qualified stock options $1.225 2/18/99 A 15,000 (1) 2/19/09 Common 15,000
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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130,000 D
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Explanation: (1) Options vest over twelve (12) months: 3,750 on 5/18/99; 3,750 on 2/18/00.
3,750 on 11/18/99 and final 3,750 options on 2/18/00
Intentional misstatements or omissions of facts constitute Federal William G. Skelly March 8, 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.
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.
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