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OMB APPROVAL
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- ------ OMB Number: 3235-0287
FORM 4 Expires: February 1, 2001
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hours per response .... 1.0
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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)
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(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- ---
Number of Reporting Month/Year X Officer (give Other (Specify
c/o Halsey Drug Co., Inc Person (Voluntary) 1/00 ---- title --- below)
695 N. Perryville Rd. Bldg. 2 below)
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(Street) 5. If Amendment, Vice President & Chief
Date of Original Financial Officer
Rockford, Illinois 61107 (Month/Year) ------------------------
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(City) (State) (Zip)
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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 1/1/00 A* 1,195 A* $1.3281 D
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3.370 D
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(Print or Type Responses)
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
SFC 1474 (3/91)
*See footnote 2 on Table II
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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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<CAPTION>
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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
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
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5% Convertible Senior $1.404 3/10/98 A (1) 3/10/98 3/15/03 Common 71,225
Secured Debentures Stock
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Warrants $1.404 3/10/98 A (1) 3/10/98 3/15/05 Common 10,101
Stock
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Warrants $2.279 3/10/98 A (1) 3/10/98 3/15/05 Common 10,101
Stock
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5% Convertible Senior $1.404 6/12/98 A4 (2) 6/12/98 3/15/03 Common 17,121
Secured Debentures Stock
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Warrants $1.404 6/12/98 A4 (2) 6/12/98 3/15/05 Common 2,428
Stock
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Warrants $2.279 6/12/98 A4 (2) 6/12/98 3/15/05 Common 2,428
Stock
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Non-qualified Stock $2.375 2/19/98 A4 (3) 2/19/08 Common 300,000
Options Stock
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5% Convertible Senior $1.1312 4/1/99 A (2) 4/1/99 3/15/03 Common 1,370
Secured Debentures Stock
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Non-qualified Stock $1.125 4/12/99 A (4) 3/8/00 3/8/09 Common 100,000
Options Stock
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5% Convertible Senior $2.4250 7/1/99 A (2) 7/1/99 3/15/03 Common 647
Secured Debentures Stock
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<CAPTION>
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9. Number of 10. Ownership 11. Nature of
Derivative Form of Indirect
Securities Derivative Beneficial
Beneficially Security: Ownership
Owned at End Direct (D) (Instr. 4)
of Month or Indirect (I)
(Instr. 4) (Instr. 4)
<S> <C> <C> <C>
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5% Convertible Senior 71,225 D
Secured Debentures
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Warrants 10,101 D
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Warrants 10,101 D
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5% Convertible Senior 17,121 D
Secured Debentures
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Warrants 2,428 D
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Warrants 2,428 D
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Non-qualified Stock 300,000 D
Options
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5% Convertible Stock 1,370 D
Secured Debentures
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Non-qualified Stock 100,000 D
Options
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5% Convertible Stock 647 D
Secured Debentures
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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 (10,101 shares of which are presently exercisable at $1.404 per share and 10.101 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 share of common stock (2,428 shares of which are presently exercisable at $1.404 per share and 2,428 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 share of common stock of the Issuer (See Table 1).
(3) Options vest quarterly, with 25,000 options vesting every quarter effective May 1, 1998.
(4) Options vest 25% annually, with 25,000 options vesting every March 8, beginning March 8, 2000.
By: /s/ Peter A. Clemens February 9, 2000
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Peter A. Clemens Date
**Signature of Reporting Person
**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. Page 2
If space provided is insufficient, see Instruction 6 for procedure.
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