1 ------------------------------ OMB APPROVAL ------------------------------ OMB Number 3235-0287 Expires: February 1, 2000 Estimated average burden 0.5 hours ------------------------------ U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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 [_] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). - -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Reicher Michael K. - -------------------------------------------------------------------------------- (Last) (First) (Middle) c/o Halsey Drug Co., Inc. 695 N. Perryville Rd. Bldg. 2 - -------------------------------------------------------------------------------- (Street) Rockford Illinois 61107 - -------------------------------------------------------------------------------- (City) (State) (Zip) - -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol Halsey Drug Co., Inc. Symbol: HDG - -------------------------------------------------------------------------------- 3. IRS or Social Security Number of Reporting Person (Voluntary) - -------------------------------------------------------------------------------- 4. Statement for Month/Year 10/99 - -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) - -------------------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [_] 10% Owner [X] Officer (give title below) [_] Other (specify below) Chief Executive Officer - -------------------------------------------------------------------------------- 7. Individual or Group Filing (Check Applicable Line) [X] Form filed by one Reporting Person [_] Form filed by more than one Reporting Person - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned - -------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- 6. 4. 5. Owner- Securities Acquired (A) or Amount of ship 3. Disposed of (D) Securities Form: 7. Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of 2. Code ------------------------------------ Owned at End (D) or In-direct 1. Transaction (Instr. 8) (A) of Month Indirect Beneficial Title of Security Date ------------- Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (Month/Day/Year) Code V (D) and 4) (Instr.4) (Instr. 4) - --------------------------------------------------------------------------------------------------------------------------------- Common Stock 10/1/98 A* 2,186 A* $1.8406 D - --------------------------------------------------------------------------------------------------------------------------------- Common Stock 1/1/99 A* 3,462 A* $1.1625 5,648 D ================================================================================================================================= 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) * See Footnote 2 to Table II. 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) ================================================================================ 10. 9. Owner- Number ship of Form 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or Derivative 6. of Underlying 8. ities Secur- of Exer- 4. Securities Date Securities Price Bene- ity: In- cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ ------- ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Secured Common Debentures $ 1.404 3/10/98 A (1) 3/10/98 3/15/03 Stock 213,675 213,675 D - ------------------------------------------------------------------------------------------------------------------------------------ Common Warrants $ 1.404 3/10/98 A (1) 3/10/98 3/15/05 Stock 30,303 30,303 D - ------------------------------------------------------------------------------------------------------------------------------------ Common Warrants $ 2.279 3/10/98 A (1) 3/10/98 3/15/05 Stock 30,303 30,303 D - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Secured Common Debentures $ 1.404 6/12/98 A4 (2) 6/12/98 3/15/03 Stock 51,363 51,363 D - ------------------------------------------------------------------------------------------------------------------------------------ Common Warrants $ 1.404 6/12/98 A4 (2) 6/12/98 3/15/05 Stock 7,284 7,284 D - ------------------------------------------------------------------------------------------------------------------------------------ Common Warrants $ 2.279 6/12/98 A4 (2) 6/12/98 3/15/05 Stock 7,284 7,284 D - ------------------------------------------------------------------------------------------------------------------------------------ Non-qualified Common Stock Options $ 2.375 2/19/98 A4 (3) 2/19/08 Stock 1,000,000 1,000,000 D - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Secured Common Debentures $1.1312 4/1/99 A (2) 4/1/99 3/15/03 Stock 4,111 4,111 D - ------------------------------------------------------------------------------------------------------------------------------------ Non-qualified Common Stock Options $ 1.125 4/12/99 A (4) 3/8/00 3/8/09 Stock 100,000 100,000 D - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Secured Common Debentures $2.4250 7/1/99 A (2) 7/1/99 3/15/03 Stock 1,939 1,939 D - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Secured Common Debentures $2.3063 10/1/99 A (2) 10/1/99 3/15/03 Stock 1,789 1,789 D ==================================================================================================================================== 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 (30,303 shares of which are presently exercisable at $1.404 per share and 30,303 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 shares of common stock (7,284 shares of which are presently exercisable at $1.404 per share and 7,284 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 shares of common stock of the Issuer (See Table I). (3) Options vest quarterly, with 62,500 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. /s/ Michael K. Reicher November 9, 1999 - --------------------------------------------- ----------------------- Michael K. Reicher 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. If space provided is insufficient, see Instruction 6 for procedure.