FORM 4 OMB APPROVAL ---------------------------- OMB NUMBER: 3235-0287 Expires: February 1, 2001 Estimated average burden hours per response.....1.0 ---------------------------- U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP [ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See instruction 1(b). 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 Clemens Peter A. - -------------------------------------------------------------------------------- (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: HDGC ________________________________________________________________________________ 3. IRS or Social Security Number of Reporting Person, (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Year 07/02 ________________________________________________________________________________ 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) Vice President & Chief Financial Officer ================================================================================ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ================================================================================ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (over) * See footnote 2 on Table II (Print or Type Responses) SFC 1474 (3/91)
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 Indirect 1. Transaction (Instr. 8) (A) of Month Indirect Beneficial Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ==================================================================================================================================== 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 1.34 74,626 Debentures (6) 3/10/98 A (1) 3/10/98 3/15/03 Common (6) D Stock - ------------------------------------------------------------------------------------------------------------------------------------ $1.34 11,028 Warrants (6) 3/10/98 A (1) 3/10/98 3/15/05 Common (6) D Stock - ------------------------------------------------------------------------------------------------------------------------------------ Warrants $2.279 3/10/98 A (1) 3/10/98 3/15/05 Common 10,526 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Secured $1.34 17,938 Debentures (6) 6/12/98 A (2) 6/12/98 3/15/03 Common (6) D Stock - ------------------------------------------------------------------------------------------------------------------------------------ $1.34 2,718 Warrants (6) 6/12/98 A (2) 6/12/98 3/15/05 Common (6) D Stock - ------------------------------------------------------------------------------------------------------------------------------------ Warrants $2.279 6/12/98 A (2) 6/12/98 3/15/05 Common 2,530 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ Non-qualified Stock Options $2.375 2/19/98 A (3) 2/19/08 Common 300,000 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Secured Debentures $1.1312 4/1/99 A (5) 4/1/99 3/15/03 Common 1,370 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ Non-qualified Stock Options $1.125 4/12/99 A (4) 4/12/00 4/12/09 Common 100,000 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Secured Debentures $2.4250 7/1/99 A (5) 7/1/99 3/15/03 Common 647 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ Non-qualified Stock Options $1.875 2/17/00 A (4) 2/17/01 2/17/10 Common 125,000 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Secured Debentures $1.722 4/1/00 A (5) 4/1/00 3/15/03 Common 923 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ Non-qualified Stock Options $1.1125 6/29/00 A (4) 6/29/01 6/29/10 Common 100,000 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Secured Debentures $1.1125 7/1/00 A (5) 7/01/00 3/15/03 Common 1,446 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Secured Debentures $ .9071 10/1/00 A (5) 10/01/00 3/15/03 Common 1,709 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Secured Debentures $ .6258 01/01/01 A (5) 01/01/01 3/15/03 Common 2,477 D Stock 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 (11,028 shares of which are presently exercisable at $1.34 per share and 10,526 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 (2,718 shares of which are presently exercisable at $1.34 per share and 2,530 shares of which are presently exercisable at $2.279 per share. (3) Options vest quarterly, with 25,000 options vesting every quarter effective May 1, 1998. (4) Options vest 25% annually. (5) Certain quarterly interest payments are paid in the form of convertible debentures. (6) Adjusted to reflect results of an anti-dilution calculation contained in the instrument. By: /s/ Peter A. Clemens July 20, 2002 --------------------------------------------- ----------------------- 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. If space provided is insufficient, see Instruction 6 for procedure. Page 2
- ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Secured Debentures $1.03 04/01/01 A (5) 04/01/01 3/15/03 Common 1,505 Stock - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Secured Debentures $2.22 07/01/01 A (5) 07/01/01 3/15/03 Common 698 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Secured Debentures $2.22 10/01/01 A (5) 10/01/01 3/15/03 Common 698 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Secured Debentures $1.86 01/01/02 A (5) 01/01/02 3/15/03 Common 833 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Secured Debentures $2.02 04/01/02 A (5) 04/01/02 3/15/03 Common 767 D Stock - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Secured Debentures $1.72 07/01/02 A (5) 07/01/02 3/15/03 Common 901 758,340 D Stock ====================================================================================================================================