1 --------------------------- OMB APPROVAL --------------------------- - -------- OMB Number: 3235-0104 FORM 3 Expires: May 31, 1994 - -------- Estimated average burden hours per response .... 0.5 --------------------------- U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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
- ----------------------------------------------------------------------------------------------------------------------------------- 1. Name and Address of Reporting Person 2. Date of Event Requiring 4. Issuer Name and Ticker or 6. If Amendment, Date Sumner William Statement Trading Symbol of Original - ---------------------------------------- (Month/Day/Year) Halsey Drug Co., Inc. (HDG) (Month/Day/Year) (Last) (First) (Middle) 2/19/98 ------------------------------ ---------------------------- 5. Relationship of Reporting 7. Individual or Joint/ - ---------------------------------------- 3. IRS or Social Security Person to Issuer Group Filing (Check (Street) Number of Reporting (Check all applicable) Applicable Line) Person (Voluntary) _X_ Director ___ 10% Owner _X Form filed by One 163 Phelps Road ###-##-#### ___ Officer ___ Other Reporting Person - -------------------------------------- ---------------------------- (give title below) (specify below) __ Form filed by More (City) (State) (Zip) than One Reporting Ridgwood, New Jersey 07450 --------------------------- Person - ----------------------------------------------------------------------------------------------------------------------------------- TABLE 1 -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ----------------------------------------------------------------------------------------------------------------------------------- 1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect (Instr. 4) Beneficially Owned Direct (D) or Beneficial (Instr. 4) Indirect (I) Ownership (Instr. 5) (Instr. 5) - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) (Print or Type Responses) SEC 1473 (8/92) 2
FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect (Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership Expiration Date Derivative Security Exercise Form of (Instr. 5) (Month/Day/ (Instr. 4) Price of Deriv- Year) Deri- ative vative Security: Security Direct ------------------------------------------------- (D) or Date Expira- Amount or Indirect (I) Exercis- tion Title Number (Instr. 5) able Date of Shares - ------------------------------------------------------------------------------------------------------------------------------------ Stock Option * * Common Stock 10,000 $2.38 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: *Date of grant of stock option March 10, 1998; Date Exercisable and Expiration Date to be determined. /s/ William Sumner March 24, 1998 **Intentional misstatements or omissions of facts constitute Federal 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. SEC 1473 (8/92)