-----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, Eqe+5ZdGkQvZPMqj7fRyD1tg+O1nhysFw6UdOlp60o57PuXB7/KJ1LAENsVbMNVP xd6dojMxiQI6RPR+OIVisA== 0001021408-02-002753.txt : 20020414 0001021408-02-002753.hdr.sgml : 20020414 ACCESSION NUMBER: 0001021408-02-002753 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020201 FILED AS OF DATE: 20020222 COMPANY DATA: COMPANY CONFORMED NAME: CROOK NEIL CENTRAL INDEX KEY: 0001128669 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 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: 02556452 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 4 1 d4.txt FORM 4 - NEIL CROOK /------------------------------/ / OMB APPROVAL / /------------------------------/ / OMB Number: 3235-0287 / / Expires: September 30, 1996 / / 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* CROOK NEIL A.M - -------------------------------------------------------------------------------- (Last) (First) (Middle) UL Bokserska 66A - -------------------------------------------------------------------------------- (Street) WARSAW POLAND 02-690 - -------------------------------------------------------------------------------- (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 2/02 - -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) - -------------------------------------------------------------------------------- 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [_] Director [_] 10% Owner [X] Officer (give title below) [_] Other (specify below) CHIEF FINANCIAL 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
- ------------------------------------------------------------------------------------------------------------------------------------ 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) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Table II--Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
- ----------------------------------------------------------------------------------------------------------------------------- 1. Title of Derivative 2. Conver- 3. Trans- 4. Transac- 5. Number of Deriv- Security (Instr. 3) sion or action tion Code ative Securities Exercise Date (Instr. 8) Acquired (A) or Price of (Month/ Disposed of (D) Deriv- Day/ (Instr. 3, 4, and 5) ative Year) Security --------------------------------------------------- Code V (A) (D) - ----------------------------------------------------------------------------------------------------------------------------- Director Stock Options $11.15 1/7/02 A 15,000 - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - -----------------------------------------------------------------------------------------------------------------------------
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- cisable and Underlying Securities of of Deriv- ship Expiration (Instr. 3 and 4) Deriv- ative Form: Date ative Secur- Direct (Month/Day/ Secur- ities (D) or Year) ity Bene- Indirect (Instr. ficially (I) -------------------------------------------- 5) Owned (Instr. 4) Date Expira- Amount or at End Exer- tion Title Number of of cisable Date Shares Month (Instr. 4) - ---------------------------------------------------------------------------------------------- Common (D) 2/7/03 2/7/12 Stock 15,000 - ---------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------
(Print or Type Responses) (Over) Explanation of Responses: ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Neil Crook 2/22/02 - ------------------------------- ----------------- **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-----