SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
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Check this 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*
SMITH ALAN J

(Last) (First) (Middle)
C/O ACURA PHARMACEUTICALS, INC.
616 N. NORTH COURT, SUITE 120

(Street)
PALATINE IL 60067

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
HALSEY DRUG CO INC/NEW [ HDGC.OB ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
Officer (give title below) X Other (specify below)
Director term exp Aug 12, 2004
3. Date of Earliest Transaction (Month/Day/Year)
08/12/2004
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/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
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Director Stock Options $0.36 08/12/2004 A 0(1) 08/12/2004(2) 08/12/2006 Common Stock 100,000(1) $0 150,000 D
Director Stock Options $0.36 08/12/2004 A 0(1) 08/13/2004 08/12/2006 Common Stock 100,000(1) $0 250,000 D
5% Convertible Senior Secured Debentures(2) $0.5776 08/13/2004 C 12,950 08/13/2004 08/13/2004 Preferred Stock 22,421 $0 0 D
5% Convertible Senior Secured Debentures(3) $0.5993 08/13/2004 C 13,948 08/13/2004 08/13/2004 Preferred Stock 23,273 $0 0 D
Series C-1 Convertible Preferred Stock (4) 08/13/2004 C 22,421 (5) (6) Common Stock 22,421 $0 22,421 D
Series C-2 Convertible Preferred Stock (4) 08/13/2004 C 23,273 (5) (6) Common Stock 23,273 $0 23,273 D
Explanation of Responses:
1. Options to purchase 100,000 shares of the Issuer's common stock, $.01 par value per share.
2. 5 % Convertible Senior Secured Debentures, due March 31, 2006, are automatically convertible into Series C-1 Convertible Preferred Stock of the Issuer on August 13, 2004.
3. 5% Convertible Senior Secured Debentures, due March 31, 2006, are automatically covnertible into Series C-2 Convertible Preferred Stock of the Issuer on August 13, 2004.
4. 1-for-1
5. Immed.
6. None
/s/ Alan J. Smith 08/12/2004
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** 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 is insufficient, see Instruction 6 for procedure.
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