-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, KqcHqNQIUdU1kGv7VkfrVIt1Z8dsc5EvlKiSwam4Z5wG6wrAvO3zop/h04M+PT9J AebdQGOwlTmgvBge+dK3cw== 0000950123-00-000912.txt : 20000210 0000950123-00-000912.hdr.sgml : 20000210 ACCESSION NUMBER: 0000950123-00-000912 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000101 FILED AS OF DATE: 20000209 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: HALSEY DRUG CO INC/NEW CENTRAL INDEX KEY: 0000786947 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 110853640 STATE OF INCORPORATION: NY FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 001-10113 FILM NUMBER: 528619 BUSINESS ADDRESS: STREET 1: 1827 PACIFIC ST CITY: BROOKLYN STATE: NY ZIP: 11233 BUSINESS PHONE: 7184677500 MAIL ADDRESS: STREET 2: 695 N. PERRYVILLE ROAD CITY: ROCKFORD STATE: IL ZIP: 61107 COMPANY DATA: COMPANY CONFORMED NAME: HEITMEYER STEPHANIE K CENTRAL INDEX KEY: 0001058984 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 17759 ST RT 66 CITY: FT JENNINGS STATE: OH ZIP: 45844 BUSINESS PHONE: 7184677500 MAIL ADDRESS: STREET 1: C/O HALSEY DRUG CO INC STREET 2: 1827 PACIFIC STREET CITY: BROOKLYN STATE: NY ZIP: 11233 4 1 HALSEY DRUG CO., INC. 1 --------------------------- OMB APPROVAL --------------------------- - ------ OMB Number: 3235-0287 FORM 4 Expires: February 1, 2001 - ------ Estimated average burden hours per response .... 1.0 --------------------------- U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP / / Check this 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(l) of the Investment Company Instruction 7(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 Heimeyer Stephanie K. Halsey Drug Co., Inc. Symbol: HDG Issuer (Check all applicable) - --------------------------------------------------------------------------------------------- Director 10% Owner (Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- --- c/o Halsey Drug Co., Inc. Number of Reporting Month/Year X Officer (give Other (Specify 695 N. Perryville Rd. Bldg. 2 Person (Voluntary) 1/00 ---- title --- below) - --------------------------------------------- ------------------- below) (Street) 5. If Amendment, Date of Original Vice President - Sales Rockford, Illinois 61107 (Month/Year) ------------------------ - --------------------------------------------- (City) (State) (Zip) - ------------------------------------------------------------------------------------------------------------------------------------ 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 1/1/00 A* 233 A* $1.3281 D - ------------------------------------------------------------------------------------------------------------------------------------ 634 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Report on a separate line for each class of securities beneficially owned directly or indirectly. (over) SFC 1474 (3/91) (Print or Type Responses) * See footnote 2 on Table II
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 - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Common Secured Debentures $1,404 3/10/98 A (1) 3/10/98 3/15/03 Stock 14,245 - ------------------------------------------------------------------------------------------------------------------------------------ Common Warrants $1,404 3/10/98 A (1) 3/10/98 3/15/05 Stock 2,020 - ------------------------------------------------------------------------------------------------------------------------------------ Common Warrants $2,279 3/10/98 A (1) 3/10/98 3/15/05 Stock 2,020 - ------------------------------------------------------------------------------------------------------------------------------------ 5% Convertible Senior Common Secured Debentures $1,404 6/12/98 A4 (2) 6/12/98 3/15/03 Stock 3,424 - ------------------------------------------------------------------------------------------------------------------------------------ Common Warrants $1,404 6/12/98 A4 (2) 6/12/98 3/15/05 Stock 485 - ------------------------------------------------------------------------------------------------------------------------------------ Common Warrants $2,279 6/12/98 A4 (2) 6/12/98 3/15/05 Stock 485 - ------------------------------------------------------------------------------------------------------------------------------------ Non-qualified Stock Common Options $2,375 2/19/98 A4 (3) 2/19/08 Stock 40,000 - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------- 9. Number of 10. Ownership 11. Nature of Derivative Form of Indirect Securities Derivative Beneficial Beneficially Security: Ownership Owned at End Direct (D) (Instr. 4) of Month or Indirect (I) (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------- 5% Convertible Senior Secured Debentures 14,245 D - ------------------------------------------------------------------------------------------------- Warrants 2,020 D - ------------------------------------------------------------------------------------------------- Warrants 2,020 D - ------------------------------------------------------------------------------------------------- 5% Convertible Senior Secured Debentures 3,424 D - ------------------------------------------------------------------------------------------------- Warrants 485 D - ------------------------------------------------------------------------------------------------- Warrants 485 D - ------------------------------------------------------------------------------------------------- Non-qualified Stock Options 40,000 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 (2,020 shares of which are presently exercisable at $1,404 per share and 2,020 shares of which are presently exercisable at $2,279 per share). (2) Acquired pursuant to an option exercise in June 1998, consisting of: (1) a Convertible Debenture, convertible at any time, (ii) Warrants to purchase share of common stock (485 shares of which are presently exercisable at $1,404 per share and 485 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 share of common stock of the Issuer (See Table 1). (3) Options vest quarterly, with 10,000 options vesting every quarter effective May 1, 1999. By: /s/ Stephanie K. Heitmeyer February 9, 2000 ------------------------------- --------------- Stephanie K. Heitmeyer 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. Note: File three copies of this Form, one of which must be manually signed. If spaced provided is insufficient, see Instruction 6 for procedure.
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