-----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, WVvl3pE34MnGx/9oIwnHyB244govtwZ+WRqq4dgeJcvkAzDS/w351rSO0eYbUcVC BEv1GfFBpFqTWdKATUfNLg== 0001016843-01-000121.txt : 20010312 0001016843-01-000121.hdr.sgml : 20010312 ACCESSION NUMBER: 0001016843-01-000121 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20010301 FILED AS OF DATE: 20010308 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: 1563747 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: 4 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 4 1 0001.txt ------------------------------ OMB APPROVAL ------------------------------ OMB Number 3235-0287 Expires: September 30,1998 Estimated average burden hours per response ....... 0.5 ------------------------------ U.S. 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(f) of the Investment Company Act of 1940 [_] Check box if no longer subject of Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). ________________________________________________________________________________ 1. Name and Address of Reporting Person* CROOK NEIL A.M. - -------------------------------------------------------------------------------- (Last) (First) (Middle) UL CYBERNETYKI 17 - -------------------------------------------------------------------------------- (Street) WARSAW POLAND - -------------------------------------------------------------------------------- (City) (State) (Zip) CENTRAL EUROPEAN DISTRIBUTION CORP. (CEDC) - -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Year 03/2001 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ================================================================================ 6. Relationship of Reporting Person to Issuer (Check all applicable) [ ] Director [ ] 10% Owner [X] Officer (give title below) [ ] Other (specify below) CHIEF EXECUTIVE OFFICER ________________________________________________________________________________ 7. Individual or Joint/Group Filing (Check applicable line) [X] Form filed by one Reporting Person [_] Form filed by more than one Reporting Person ________________________________________________________________________________ ================================================================================ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ================================================================================
6. 4. 5. Owner- Securities Acquired (A) or Amount of ship 3. Disposed of (D) Securities Form: 7. Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of 2. Code ------------------------------- Owned at End (D) or Indirect 1. Transaction (Instr. 8) (A) of Month Indirect Beneficial Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ CEDC Common Stock 10,000 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Page 1 of 3 TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
5. Number of Derivative Securities Acquired 1. Title of Derivative 2. Conversion of Exercise 3. Transaction Date 4. Transaction (A) or Disposed or (D) Security (Instr. 3) Price of Derivative Security (Month/Day/Year) Code (Instr. 8) (Instr. 3, 4 and 5) - -------------------------------------------------------------------------------------------------------------------------------- Code V (A) (D) Central European Distribution Corporation Common Stock $3.50 2/7/01 A 5,000
TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
10. Ownership Form of 11. Nature of 7. Title and Derivative Indirect Amount of 8. Price of 9. Number of Security: 6. Date Exercisablt Underlying Derivative Derivative Securities Direct (D) or Beneficial Securities Security Beneficially Owned at Indirect (I) and Expiration Date (Intr. 3 and 4) (Instr. 5) End of Month (Instr. 4) Instr. 4) Ownership (Month/Day/Year) (Instr. 4) - ----------------------------------------------------------------------------------------------------------------------------------- (D) Date Expiration Title Amount Exercisable Date or Number of Shares 2/07/02 2/07/2012 Common 5,000 15,000 (D) Stock
(Print or Type Responses) (Over) (Form 4-07/98) Explanation of Responses: ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ NEIL A.M. CROOK 03/08/01 - --------------------------------------------- ----------------------- **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 of 3 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP FORM 4 (Continuation Sheet) Item 1. Name: Item 2. Issuer: Item 3. Social Securitiy Number: Item 4. Statement of Month of: - -------------------------------------------------------------------------------- Explanation of Response: Table 1: Table 2: THE FILING OF THIS STATEMENT SHALL NOT BE CONSTRUED AS AN ADMISSION THAT THE REPORTING PERSON IS, FOR THE PURPOSES OF SECTION 16 OF THE SECURITIES EXCHANGE ACT OF 1934, AS AMENDED, THE BENEFICIAL OWNER OF AN EQUITY SECURITIES COVERED BY THIS STATAEMENT. Page 3 of 3 -----END PRIVACY-ENHANCED MESSAGE-----