1 - ------ FORM 4 - ------ ----------------------------- OMB APPROVAL ---------------------------- OMB Number 2236-0287 Expires: February 1, 2000 Estimated average burden: 0.5 hours ----------------------------- U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP / / Check 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 - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to Smith Alan J. Halsey Drug Co., Inc. Symbol: HDG Issuer - ------------------------------------------- -------------------------------------------- X Director 10% Owner (Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- --- c/o Halsey Drug Co. Number of Reporting Month/Year Officer (give Other (Specify 695 N. Perryville Rd. Bldg. 2 Person (Voluntary) 2/99 ---- title --- below) - --------------------------------------------- ------------------- below) (Street) -------------------- 5. If Amendment, __________________________________ Rockford Illinois 61107 Date of Original 7. Individual or Group Filing - --------------------------------------------- (Month/Year) (Check Applicable Line) (City) (State) (Zip) X Form filed by One Reporting Person ------------ __ __ Form filed by more than one Reporting Person - ------------------------------------------------------------------------------------------------------------------------------------ TABLE 1 -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 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) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 4,600 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (over) * If the Form is filed by more than one person, see Instruction 4(b)(v). SFC 1474 (3/91)
2 FORM 4 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 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) ----------------------------------- Date Expira- Amount or -------------------------- Exer- tion Title Number of Code V (A) (D) cisable Date Shares - ------------------------------------------------------------------------------------------------------------------------------------ Convertible Debentures (1) 3/10/98 3/10/03 Common 6,667 Stock - ------------------------------------------------------------------------------------------------------------------------------------ Stock Purchase Warrants (1) 3/10/98 3/10/05 Common 1,010 Stock - ------------------------------------------------------------------------------------------------------------------------------------ Stock Purchase Warrants (1) 3/10/98 3/10/05 Common 1,010 Stock - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior $1.50 6/15/98 A4 (2) 6/15/98 ** Common 1,602.66 Secured Notes Stock - ------------------------------------------------------------------------------------------------------------------------------------ Warrant $1.50 6/15/98 A4 (2) 6/15/98 6/15/05 Common 243 Stock - ------------------------------------------------------------------------------------------------------------------------------------ Warrant $2.375 6/15/98 A4 (3) 6/15/98 6/15/05 Common 243 Stock - ------------------------------------------------------------------------------------------------------------------------------------ 10% Convertible Senior $1.3313 12/7/98 A4 (3) 12/7/98 * Common 6,009 Secured Notes Stock - ------------------------------------------------------------------------------------------------------------------------------------ Warrants $1.3313 12/7/98 A4 (3) 12/7/98 12/7/05 Common 800 Stock - ------------------------------------------------------------------------------------------------------------------------------------ Non-qualified $1.225 2/18/99 A 10,000 (4) 12/19/09 Common 10,000 stock option Stock - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ 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) - ------------------------------------------------------------------------------------------------------- Convertible Debentures 6,667 D - ------------------------------------------------------------------------------------------------------- Stock Purchase Warrants 1,010 D - ------------------------------------------------------------------------------------------------------- Stock Purchase Warrants 1,010 D - ------------------------------------------------------------------------------------------------------- 5% Convertible Senior Secured Notes 1,602.66 D - ------------------------------------------------------------------------------------------------------- Warrant 243 D - ------------------------------------------------------------------------------------------------------- Warrant 243 D - ------------------------------------------------------------------------------------------------------- 10% Convertible Senior 6,009 D Secured Notes - ------------------------------------------------------------------------------------------------------- Warrants 800 D - ------------------------------------------------------------------------------------------------------- Non-qualified 20,000 D - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- Explanations: (1) Acquired in connection with a private offering on 3/10/98 consisting of a Convertible Debenture exercisable at any time and Warrants to purchase shares of common stock (1,010 shares of which are presently exercisable at $1.50 per share and 1,010 shares of which are presently exercisable at $2.38 per share). (2) Acquired pursuant to an option exercise in June 1998, consisting of: (i) a Convertible Debenture exercisable at any time; and (ii) Warrants to purchase shares of common stock (243 shares of which are presently exercisable at $1.50 per share, and 243 shares of which are presently exercisable at $2.375 per share). (3) Acquired in connection with a loan in principal amount of $8,000 made pursuant to the First Amendment to the Amended, Restated and Consolidated Bridge Loan Agreement dated as of December 7, 1998 consisting of: (i) a 10% Convertible Senior Secured Note; and (ii) Warrants to purchase common stock which are presently exercisable at $1.3313 per share. (4) Options vest over twelve (12) months: 2,500 on 5/18/99; 2,500 on 8/18/99; 2,500 on 11/18/99 and final 2,500 options on 2/18/00. * Payable on May 30, 19999 to the Holder (Alan Smith). ** Payable on March 15, 2003 to the Holder (Alan Smith). Intentional misstatements or omissions of facts constitute Federal /s/ Alan J. Smith March 9, 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. Page 2 If space provided is insufficient, see Instruction 6 for procedure. (Bulletin No. 177, 10-15-97) 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 QMB Number.