4 1 d4.txt FORM 4 - TONY HOUSH /------------------------------/ / OMB APPROVAL / /------------------------------/ / OMB Number: 3235-0387 / / 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 this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Housh Tony -------------------------------------------------------------------------------- (Last) (First) (Middle) Millenium Capital Bracka 25, 4/th/ Floor -------------------------------------------------------------------------------- (Street) Warsaw Poland 00-208 -------------------------------------------------------------------------------- (City) (State) (Zip) CENTRAL EUROPEAN DISTRIBUTION CORP. (CEDC) -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol -------------------------------------------------------------------------------- 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 to Issuer (Check all applicable) [X] Director [_] 10% Owner [_] Officer (give title below) [_] Other (specify below) -------------------------------------------------------------------------------- 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 Forms 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 A 6,000 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)
Derivative 5. Number of Acquired Securities 1. Title of Derivative 2. Conversion of Exercise 3. Transaction Date 4. Transaction (A) or Disposed Security (Instr. 3) Price of Derivative Security (Month/Day/Year) Code (Inst. 8) --------------------------------------------------- Code V (A) (D) ----------------------------------------------------------------------------------------------------------------------------- Central European Distribution Corporation Common Stock $3.79 4/27/01 A 1,500 ----------------------------------------------------------------------------------------------------------------------------- CEDC Common Stock $5.04 4/30/01 A 3,000 ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------
TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
------------------------------------------------------------------------------------------------------------------------------------ 6. Date Exer- 7. Title and Amount of 8. Price 9. Number 10. Owner- 11. Na- cisable and Underlying Securities of of Deriv- ship ture Expiration (Instr. 3 and 4) Deriv- ative Form of In- Date ative Secur- of De- direct (Month/Day/ Secur- ities rivative Bene- Year) ity Bene- Security ficial (Instr. ficially Direct (D) Owner- -------------------------------------------- 5) Owned for Indirect ship Date Expira- Amount or at End (I) (Instr. Exer- tion Title Number of of (Instr. 4) 4) cisable Date Shares Month (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ 4/27/02 4/27/11 Common Stock 1,500 $3.79 7,500 (D) ------------------------------------------------------------------------------------------------------------------------------------ 4/30/02 4/30/11 Common Stock 3,000 $5.04 10,500 (D) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses: ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Tony Housh 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