-----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, H7YRm26mo8hKKWyAowPZH8tzwp65vaPFSjhBw2n6E9Yuod8F9UBfJ53Pe8EMAiNQ xtYMxsiV+3K25s+saVo3ig== 0001021408-01-506367.txt : 20010907 0001021408-01-506367.hdr.sgml : 20010907 ACCESSION NUMBER: 0001021408-01-506367 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20010901 FILED AS OF DATE: 20010906 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: 1934 Act SEC FILE NUMBER: 000-24341 FILM NUMBER: 1732077 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: PETERSON JEFFREY CENTRAL INDEX KEY: 0001085102 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: PALM TOWER BUILDING STREET 2: 1343 MAIN STREET #301 CITY: SARSOTA STATE: FL ZIP: 34236 BUSINESS PHONE: 94133015598 MAIL ADDRESS: STREET 1: PALM TOWER BUILING STREET 2: 1343 MAIN STREET #301 CITY: SARASOTA STATE: FL ZIP: 34236 4 1 d4.txt FORM 4 /------------------------------/ / OMB APPROVAL / /------------------------------/ / OMB Number 3235-0287 / / Expires: September 31, 2001 / / 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 PETERSON JEFFREY K - -------------------------------------------------------------------------------- (Last) (First) (Middle) 1707 WALDEMERE STREET - -------------------------------------------------------------------------------- (Street) SARASOTA FL 34236 - -------------------------------------------------------------------------------- (City) (State) (Zip) 2. Issuer Name and Ticker or Trading Symbol CEDC ----------------------------------- 3. IRS Identification Number of Reporting Person, if an Entity (voluntary) - -------------------------------------------------------------------------------- 4. Statement for Month/Year 9/01 --------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) --------------------------------- 6. Relationship of Reporting Person 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- 7. Nature of action action or Disposed of (D) Securities ship of In- Security Date Code (Instr. 3, 4 and 5) Beneficially Form: direct (Instr. 3) (Month/ (Instr. 8) Owned at Direct Bene- Day/ ----------------------------------------------- End of (D) or ficial Year) Month Indirect Owner- Code V Amount (A) or Price (Instr. 3 and 4) (I) ship (D) (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ CEDC Common Stock A 628,740 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Page 1 TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
- ----------------------------------------------------------------------------------------------------------------------------- Derivative Acquired 1. Title of Derivative 2. Conver- 3. Trans- 4. Transac- 5. Number of Securities Security (Instr. 3) sion of action tion Code (A) or disposed Exercise Date (Instr. 8) or (D) Price of (Month/ (Instr. 3, 4 and 5) Deriv- Day/ ative Year) Security --------------------------------------------------- Code V (A) (D) - ----------------------------------------------------------------------------------------------------------------------------- Central European Distribution Corporation Common Stock $ 6.00 8/8/01 A 500 CEDC Common Stock $ 6.09 8/8/01 A 600 CEDC Common Stock $ 6.55 8/24/01 A 900
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 Beneficial and (Instr. 3 and 4) Deriv- ative Form of In- Expiration ative Secur- of De- direct Date Secur- ities rivative Bene- Ownership ity Bene- Security. ficial (Month/day/year) (Instr. ficially Direct (D) ship (Instr. 4) -------------------------------------------- 5) Owned or Indirect (Instr. Date Expira- Title Amount or at End (1) 4) Exer- tion Number of of Instr. (4) cisable Date Shares Month (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common 2,000 630,740 (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/ Jeffrey Peterson 9/5/01 - --------------------------------------- ----------------- ** 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. -----END PRIVACY-ENHANCED MESSAGE-----