4 1 d4.txt FORM 4 - JEFFREY PETERSON /------------------------------/ / OMB APPROVAL / /------------------------------/ / OMB Number: 3235-0287 / / Expires: September 30, 1998 / / Estimated average burden / / hours per response...... 0.5 / /------------------------------/ +--------+ | FORM 4 | U.S. SECURITIES AND EXCHANGE COMMISSION +--------+ WASHINGTON, D.C. 20549 [_] Check this box if no longer subject STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP to Section 16. Form 4 or Form 5 Filed pursuant to Section 15(a) of the Securities obligations may Exchange Act of 1934, Section 17(a) of the continue. See Public Utility Holding Company Act of 1935 or Instruction 1(b). Section 30(f) of the Investment Company Act of 1940 (Print or Type Responses) -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* PETERSON JEFFREY K. -------------------------------------------------------------------------------- (Last) (First) (Middle) 1707 Waldemere Street -------------------------------------------------------------------------------- (Street) SARASOTA FL 34239 -------------------------------------------------------------------------------- (City) (State) (Zip) 2. Issuer Name and Ticker or Trading Symbol CENTRAL EUROPEAN DISTRIBUTION CORP ---------------------------------- (CEDC) ----- 3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) -------------- 4. Statement for Month/Year 06/01 --------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) --------------------------------- 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [X] Director [X] Officer [X] 10% Owner [_] Other (give title below) (specify below) Executive Vice President ---------------------------------------------------------------- 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
------------------------------------------------------------------------------------------------------------------------------------ 1. Title 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- of action action or Disposed of (D) Securities ship Security Date Code (Instr. 3, 4 and 5) Beneficially Form: (Instr. 3) (Month/ (Instr. 8) Owned at Direct 7. Nature of Day/ ----------------------------------------------- End of (D) or Indirect Year) Month Indirect Beneficial Code V Amount (A) or Price (Instr. 3 and 4) (I) Ownership (D) (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ CEDC Common Stock A 623,740 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)
Derivatives Acquired ----------------------------------------------------------------------------------------------------------------------------- 1. Title of Derivative 2. Conversion or 3. Transaction 4. Transaction 5. Number of Security (Instr. 3) Exercise Date Code Securities Price of (Month/ (Instr. 8) (A) or Disposed Derivative Day/ or (D) Security Year) (Instr. 3, 4, and 5) --------------------------------------------------- Code V (A) (D) ----------------------------------------------------------------------------------------------------------------------------- Central European Distribution Corporation Common Stock $4.00 4/23/01 A 5,000 ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------
Table II--Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
Nature of Indirect ------------------------------------------------------------------------------------------------------------------------------------ 6. Date Exer- 7. Title and Amount of 8. Price 9. Number 10. Owner- 11. Na- cisable Underlying Securities of of Deriv- ship ture and Beneficial (Instr. 3 and 4) Deriv- ative Form of In- Expiration ative Secur- of De- direct Date Secur- ities rivative Bene- (Month/Day/ ity Bene- Security ficial Year) (Instr. ficially Direct (D) Owner- (instr. 4 ) 5) Owned or Indir- ship -------------------------------------------- at End ect (I) (Instr. Date Expira- Amount or of (instr 4) 4) Exer- tion Title Number of Month cisable Date Shares (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ 4/23/02 4/23/11 Common Stock 5,000 628,740 (D) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------
(Print or Type Responses) (Over) (Form 4-07/98) Explanation of Responses: ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ JEFFREY K. PETERSON 6/10/01 ------------------------------------------ ------------ **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