-----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, AQfntu2b1Tfy42bitp+Rh8FD3kI7WPZEuDeaNVhyNhsksVYzU1A4VMJS7lShTI5p D1qjoJw2heyOgZUPm5fDsw== 0000950168-01-000046.txt : 20010122 0000950168-01-000046.hdr.sgml : 20010122 ACCESSION NUMBER: 0000950168-01-000046 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20001206 FILED AS OF DATE: 20010108 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: 3 SEC ACT: SEC FILE NUMBER: 000-24341 FILM NUMBER: 1503512 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: CROOK NEIL CENTRAL INDEX KEY: 0001128669 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: UL CYBERNETYKI 17 STREET 2: WARSAW POLAND CITY: 02-677 MAIL ADDRESS: STREET 1: UL CYBERNETYKI 17 STREET 2: WARSAW POLAND CITY: 02-677 3 1 0001.txt INITIAL STATEMENT OF BENEFICIAL OWNERSHIP FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 OMB APPROVAL ------------ OMB Number: 3235-0104 Expires: October 31, 2001 Estimated average burden hours per response .... 0.5 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
(Print or Type Responses) 1. Name and Address of Reporting Person* 2. Date of Event Re- 4. Issuer Name and Ticker or quiring Statement Trading Symbol Crook Neil (Month/Day/Year) Central European Distribution Corporation (CEDC) - -------------------------------------- -------------------------------- (Last) (First) (Middle) 1/7/00 5. Relationship of Reporting 6. If Amendment, Date of ------------------- Person(s) to Issuer Original (Month/Day/Year) UL Cybernetyki 17 B 3. IRS or Social Se- (Check all applicable) ---------------------------- - -------------------------------------- curity Number of __ Director __10% Owner (Street) Reporting Person X_ Officer (give __Other 7. Individual or Joint/Group (Voluntary) title below)(specify below) Filing (Check Applicable Line) Warsaw Poland ------------------------ X_ Form filed by One Reporting - -------------------------------------- Person (City) (State) (Zip) __ Form filed by More than One Reporting Person
Table I - Non Derivative Securities Beneficially Owned - -------------------------------------------------------------------------------- 1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect Beneficial (Instr. 4) Beneficially Owned Form: Direct Ownership (Instr. 5) (Instr. 4) (D) or Indirect (I) (Instr. 5) - ------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------
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 5(b)(v). (Over) SEC 1473 (7-97) FORM 3 (continued) Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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 Ownership Expiration (Instr. 4) Exercise Form of (Instr. 5) Date Price of Deriv- (Month/Day/ Deri- ative Year) vative Security: ------------------------------------------------ Security Direct Date Expira- Title Amount (D) or Exer- tion or Indirect cisable Date Number (I) of Shares (Instr. 5) - ---------------------------------------------------------------------------------------------------------------------------------- Employee Stock Option 1/7/01 1/7/11 Common Stock 5,000 4,875 D - ---------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses: /s/ Neil Crook 12/06/00 ------------------------- ----------------- ** Signature of Reporting Date Person * Initial public offering price pursuant to Prospectus dated April 23, 1998. ** 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 provided 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 1473 (7-97) -----END PRIVACY-ENHANCED MESSAGE-----