-----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, NSGOhMmJaBZralLHcSvIARE50mJeOinhyOMGkH812qaaodiOmREbQ8bTjGVTULx/ saTjLgju0keKOf0S2zwoPQ== 0000950168-00-002586.txt : 20001215 0000950168-00-002586.hdr.sgml : 20001215 ACCESSION NUMBER: 0000950168-00-002586 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20001206 FILED AS OF DATE: 20001214 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: CENTRAL EUROPEAN DISTRIBUTION CORP CENTRAL INDEX KEY: 0001046880 STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-BEER, WINE & DISTILLED ALCOHOLIC BEVERAGES [5180] IRS NUMBER: 541865271 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-24341 FILM NUMBER: 788948 BUSINESS ADDRESS: STREET 1: PALM TOWER BUILDING STREET 2: 1343 MAIN STREET SUITE 301 CITY: SARASOTA STATE: FL ZIP: 34236 BUSINESS PHONE: 9413301558 MAIL ADDRESS: STREET 1: PALM TOWER BUILDING STREET 2: 1343 MAIN STREET SUITE 301 CITY: SARASOTA STATE: FL ZIP: 34236 COMPANY DATA: COMPANY CONFORMED NAME: LASKOWSKI JAN CENTRAL INDEX KEY: 0001128668 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 10116 MARSZATKOWSKA M6 STREET 2: WARSZAWA POLAND CITY: 00-102 MAIL ADDRESS: STREET 1: 10116 MARSZATKOWSKA M6 STREET 2: WARSZAWA POLAND CITY: 00-102 4 1 0001.txt STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL [ ] CHECK THIS BOX IF NO LONGER WASHINGTON, D.C. 20549 OMB NUMBER 3235-0287 SUBJECT TO SECTION 16. FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP EXPIRES:DECEMBER 31, 2001 OR FORM 5 OBLIGATIONS MAY ESTIMATED AVERAGE BURDEN CONTINUE. SEE INSTRUCTION 1(B). HOURS PER RESPONSE.....0.5 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 (PRINT OR TYPE RESPONSES) - ---------------------------------------------------------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or 6. Relationship of Reporting Person(s) to Issuer Trading Symbol (Check all applicable) X Director ______10% Owner ----- ______ Officer _______ Other (give title below) (specify below) Central European Distribution Corporation _____________________ Laskowski Jan W. "CEDC" - ------------------------------------------------------------------------------------------------------------------------------------ (Last) (First) (Middle) 3. IRS 4. Statement Identification for Number of Month/Year Reporting Person, if an entity (voluntary) 10/16 Marszatkowska M.6 9/00 - ----------------------------------------------------------------------------------------------------------------------------- (Street) 5. If 7. Individual or Joint/Group Filing (Check Applicable Amendment, Line) Date of X Form filed by One Reporting Person Original ___ Form filed by More than One Reporting Person 00-102 Warsaw, Poland (Month/Year) - ------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------ 1. 2. 3. 4. 5. 6. 7. - --------------------- -------- ---------- ------------------------------ ----------- ---------- ---------- Amount of Owner- Securities ship Trans- Trans- Securities Acquired (A) Beneficially Form: action action or Disposed of (D) Owned at Direct Nature of Date Code (Instr. 3, 4 and 5) End of (D) or Indirect Title of (Month/ (Instr. 8) ---------------------------- Month Indirect Beneficial Security Day/ ---------- Amount (A) or Price (Instr. (I) Ownership (Instr. 3) Year) Code V (D) 3 and 4) (Instr. 4) (Instr. 4) - --------------------- -------- ---- ---- ----------- ------ --------- ----------- ---------- ---------- Common Stock 13,000 D - ---------------------------------------------------------------------------------------------------------------------------------- -------------------------- ------------------- ------ --------------- ---- --------- -------------- ------------- ---------- -------------------------- ------------------- ------ --------------- ---- --------- -------------- ------------- ---------- -------------------------- ------------------- ------ --------------- ---- --------- -------------- ------------- ---------- -------------------------- ------------------- ------ --------------- ---- --------- -------------- ------------- ---------- -------------------------- ------------------- ------ --------------- ---- --------- -------------- ------------- ---------- -------------------------- ------------------- ------ --------------- ---- --------- -------------- ------------- ---------- -------------------------- ------------------- ------ --------------- ---- --------- -------------- ------------- ----------
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) *If the form is filed by more than one reporting person, SEE Instruction 4(b)(v) SEC 1472 (3-99) POTENTIAL PERSONS WHO ARE TO RESPOND TO THE COLLECTION OF INFORMATION CONTAINED IN THIS FORM ARE NOT REQUIRED TO RESPOND UNLESS THE FORM DISPLAYS A CURRENTLY VALID OMB CONTROL NUMBER
FORM 4 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------ 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. - ---------- -------- -------- -------- ---------- ------------ -------------- ------ ---------- --------- ---------- Title and Ownership Number of Date Exer- Amount of Form of Derivative cisable and Underlying Number of Deriv- Securities Expiration Securities Price Derivative ative Conver- Trans- Acquired (A) Date (Month/ (Instr. 3 of Securities Security: sion or Trans- action or Disposed Day/Year) and 4) Deriv- Benefi- Direct Exercise action Code of (D) -------------- -------------- ative cially (D) or Nature of Title of Price of Date (Instr. (Instr. 3, Date Amount Secur- Owned at Indirect Indirect Derivative Deriv- (Month/ 8) 4 and 5) Exer- Expir- or Num- ity End of (I) Beneficial Security ative Day/ -------- ---------- cis- ation ber of (Instr. Month (Instr. Ownership (Instr. 3) Security Year) Code V (A) (D) able Date Title Shares 5) (Instr. 4) 4) (Instr. 4) - ---------- -------- -------- ---- --- ---- ---- ------- ----- ----- ------ ------ ---------- -------- ---------- Central European Distribution Corp. Common Common Stock $4.00 5/23/00 A 5000 5/23/00 5/23/10 Stock 5000 13,000 D - ------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: ** Intentional misstatements or omissions of /s/ Jan W. Laskowski 12/14/00 facts constitute Federal Criminal 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 is insufficient, SEE Instruction 6 for procedure. - ---------------------------------------------------------------------------------------------------------------------------- Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. Page 2 SEC 1472 (3-99)
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