-----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, Foc19yUin/O+Kx0shLl/15RbUidRfvikbdiLCK+gxyhBNlcCfeLE1YuuL4MNBwP9 4PIdN8wH83yN+NUXEesccw== 0000950123-02-009387.txt : 20021003 0000950123-02-009387.hdr.sgml : 20021003 20021003124336 ACCESSION NUMBER: 0000950123-02-009387 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021002 FILED AS OF DATE: 20021003 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: CLEMENS PETER A CENTRAL INDEX KEY: 0001056695 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: C/O HALSEY DRUG CO INC STREET 2: 1827 PACIFIC STREET CITY: BROOKLYN STATE: NY ZIP: 11233 MAIL ADDRESS: STREET 1: C/O HALSEY DRUG CO INC STREET 2: 1827 PACIFIC STREET CITY: BROOKLYN STATE: NY ZIP: 11233 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: 1934 Act SEC FILE NUMBER: 001-10113 FILM NUMBER: 02780677 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 4 1 y64340e4.htm STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
 

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UNITED STATES
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(h) of the Investment Company Act of 1940

o 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*		 2. Issuer Name and Ticker or Trading
Symbol		 3. I.R.S. Identification Number of Reporting
Person, if an entity (Voluntary)
  Clemens, Peter A.
(Last) (First) (Middle)		   Halsey Drug Co., Inc. Symbol: HDGC
  
     
  C/o Halsey Drug Co., Inc.
695 N. Perryville Rd. Bldg. 2
(Street)		 4. Statement for Month/Day/Year 5. If Amendment, Date of Original (Month/Day/Year)
    10/02
  
     
    6. Relationship of Reporting Person(s)
to Issuer (Check All Applicable)		 7. Individual or Joint/Group Filing
(Check Applicable Line)
  Rockford, Illinois 61107
(City)        (State)        (Zip)		   x  Director o  10% Owner   o Form Filed by One Reporting Person
    x  Officer (give title below)   o Form Filed by More than One Reporting Person
    o  Other (specify below)  
      Vice President & Chief Financial Officer
      
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).

 

                                               
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 Sec-
urities Beneficially
Owned Following
Reported Trans-
action(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          
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         

Page 2

 
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)
                      Code V   (A) (D)
  5% Convertible Senior Secured Debentures     1.34(6)     3/10/98     A   (1)
  Warrants     $1.34(6)     3/10/98     A   (1)
  Warrants     $2.279     3/10/98     A   (1)
  5% Convertible Senior Secured Debentures     $1.34(6)     6/12/98     A   (2)
  Warrants     $1.34(6)     6/12/98     A   (2)
  Warrants     $2.279     6/12/98     A   (2)
  Non-qualified Stock Options     $2.375     2/19/98     A  
  5% Convertible Senior Secured Debentures     $1.1312     4/1/99     A   (5)
  Non-qualified Stock Options     $1.125     4/12/99     A   (4)
  5% Convertible Senior Secured Debentures     $2.4250     7/1/99     A   (5)
  Non-qualified Stock Options     $1.875     2/17/00     A   (4)
  5% Convertible Senior Secured Debentures     $1.722     4/1/00     A   (5)
  Non-qualified Stock Options     $1.1125     6/29/00     A   (4)
  5% Convertible Senior Secured Debentures     $1.1125     7/1/00     A   (5)
  5% Convertible Senior Secured Debentures     $ .9071     10/1/00     A   (5)
  5% Convertible Senior Secured Debentures     $ .6258     01/01/01     A   (5)
  5% Convertible Senior Secured Debentures     $1.03     04/01/01     A   (5)
  5% Convertible Senior Secured Debentures     $2.22     07/01/01     A   (5)
  5% Convertible Senior Secured Debentures     $2.22     10/01/01     A   (5)
  5% Convertible Senior Secured Debentures     $1.86     01/01/02     A   (5)
  5% Convertible Senior Secured Debentures     $2.02     04/01/02     A   (5)
  5% Convertible Senior Secured Debentures     $1.72     07/01/02     A   (5)
  5% Convertible Senior Secured Debentures     $1.75     10/01/02     A   (5)

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Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned — Continued
(e.g., puts, calls, warrants, options, convertible securities)
6. Date Exercisable and
Expiration Date
(Month/Day/Year)		 7. Title and Amount
of Underlying Securities
(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 of
Derivative Security:
Direct (D) or
Indirect (I)
(Instr. 4)		 11. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)
  Date
Exercisable		 Expiration
Date		   Title Amount or
Number of
Shares		                        
  3/10/98 3/15/03   Common Stock 74,626(6)               D  
  3/10/98 3/15/05   Common Stock 11,028(6)               D  
  3/10/98 3/15/05   Common Stock 10,526               D  
  6/12/98 3/15/03   Common Stock 17,938(6)               D  
  6/12/98 3/15/05   Common Stock 2,718(6)               D  
  6/12/98 3/15/05   Common Stock 2,530               D  
  (3) 2/19/08   Common Stock 300,000               D  
  4/1/99 3/15/03   Common Stock 1,370               D  
  4/12/00 4/12/09   Common Stock 100,000               D  
  7/1/99 3/15/03   Common Stock 647               D  
  2/17/01 2/17/10   Common Stock 125,000               D  
  4/1/00 3/15/03   Common Stock 923               D  
  6/29/01 6/29/10   Common Stock 100,000               D  
  7/01/00 3/15/03   Common Stock 1,446               D  
  10/01/00 3/15/03   Common Stock 1,709               D  
  01/01/01 3/15/03   Common Stock 2,477               D  
  04/01/01 3/15/03   Common Stock 1,505                
  07/01/01 3/15/03   Common Stock 698               D  
  10/01/01 3/15/03   Common Stock 698               D    
  01/01/02 3/15/03   Common Stock 833               D  
  04/01/02 3/15/03   Common Stock 767               D  
  07/01/02 3/15/03   Common Stock 901               D  
  10/01/02 3/15/02   Common Stock 883           759,223     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 (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.

/s/ Peter A. Clemens   October 2, 2002
**Signature of Reporting Person		  
Date

**   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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