1 -------------------------------- OMB-APPROVAL -------------------------------- - ------- OMB Number: 3235-0104 FORM 3 Expires: May 31, 1994 - ------- Estimated average burden hours per response...........0.5 -------------------------------- U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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 Persons 2. Date of Event Re- 4. Issuer Name and Ticker or Trading Symbol quiring Statement HEITMEYER STEPHANIE K. (Month/Day/Year) Halsey Drug Co., Inc. (HDG) - ------------------------------------------ -------------------------------------------- (Last) (First) (Middle) 5. Relationship of Reporting Person to Issuer If Amendment, 3/13/98 (Check all applicable) Date of Original ---------------------- Director ____ 10% Owner 3. IRS or Social Se- --- (Month/Day/Year) 17759 ST. RT. 66 curity Number of x Officer (give Other (specify ----------------------------------------- Reporting Person --- title below) below) (Street) (Voluntary) Vice President, Sales FT. JENNINGS, OH 45844 ###-##-#### - ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) Table 1-- Non-Derivative Securities Beneficially Owned - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Amounts of Securities 3. Ownership 4. Nature of Indirect Beneficial Ownership (Instr. 4) Beneficially Owned Form: Direct (Instr. 5) (Instr. 4) (D) or Indirect (I) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ (over) Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Responses) SFC 1473 (8-92) 2 FORM 3 (Continued) Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 300914-1
- ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Date Exer- 3. Title and Amount of Securities 4. Conver- 5. Owner- 6. Nature of Indirect (Instr. 4) cisable and Underlying Derivative Security sion or ship Beneficial Expiration (Instr. 4) Exercise Form of Ownership Date Price of Deriv- (Instr. 5) (Month/Day/ Deri- ative Year) vative Security: Security Direct ----------------------------------------------- (D) or Date Expira- Amount or Indirect Exer- tion Title Number (I) cisable Date of Shares (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ CONVERTIBLE SENIOR SECURED * * COMMON STOCK 13,333 * * D DEBENTURES - ------------------------------------------------------------------------------------------------------------------------------------ STOCK PURCHASE WARRANTS ** ** COMMON STOCK 4,040 ** ** D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: * Represents the shares issuable upon the conversion of a convertible debenture at $1.50 per share. ** Represents 4,040 shares issuable upon the exercise of common stock purchase warrants (of which 2,020 shares are exercisable at $2.38 per share and 2,020 shares are exercisable at an exercise price of $1.50 per share). **Intentional misstatements or omissions of facts constitute Federal Criminal /s/ Stephanie Heitmeyer March 27, 1998 Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ------------------------------- -------------- **Signature of Reporting Person Date 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 SEC 1473 (8-92)