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OMB APPROVAL
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- ------ OMB Number: 3235-0287
FORM 4 Expires: February 1, 2001
- ------ Estimated average burden
hours per response .... 1.0
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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(l) of the Investment Company
Instruction 7(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
Heimeyer Stephanie K. Halsey Drug Co., Inc. Symbol: 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
695 N. Perryville Rd. Bldg. 2 Person (Voluntary) 1/00 ---- title --- below)
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(Street) 5. If Amendment,
Date of Original Vice President - Sales
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* 233 A* $1.3281 D
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634 D
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Report on a separate line for each class of securities beneficially owned directly or indirectly. (over)
SFC 1474 (3/91) (Print or Type Responses)
* 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 Common
Secured Debentures $1,404 3/10/98 A (1) 3/10/98 3/15/03 Stock 14,245
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Common
Warrants $1,404 3/10/98 A (1) 3/10/98 3/15/05 Stock 2,020
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Common
Warrants $2,279 3/10/98 A (1) 3/10/98 3/15/05 Stock 2,020
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5% Convertible Senior Common
Secured Debentures $1,404 6/12/98 A4 (2) 6/12/98 3/15/03 Stock 3,424
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Common
Warrants $1,404 6/12/98 A4 (2) 6/12/98 3/15/05 Stock 485
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Common
Warrants $2,279 6/12/98 A4 (2) 6/12/98 3/15/05 Stock 485
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Non-qualified Stock Common
Options $2,375 2/19/98 A4 (3) 2/19/08 Stock 40,000
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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
Secured Debentures 14,245 D
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Warrants 2,020 D
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Warrants 2,020 D
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5% Convertible Senior
Secured Debentures 3,424 D
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Warrants 485 D
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Warrants 485 D
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Non-qualified Stock
Options 40,000 D
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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 (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: (1) a
Convertible Debenture, convertible at any time, (ii) Warrants to purchase
share 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 share of common stock of the Issuer (See Table 1).
(3) Options vest quarterly, with 10,000 options vesting every quarter effective
May 1, 1999.
By: /s/ Stephanie K. Heitmeyer February 9, 2000
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Stephanie K. Heitmeyer 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.
Note: File three copies of this Form, one of which must be manually signed.
If spaced provided is insufficient, see Instruction 6 for procedure.
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