4 1 d4.txt FORM 4 ------------------------------- 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 CHANGE IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a0 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 Parent. Grossmann James T. -------------------------------------------------------------------------------- (Last) (First) (Middle) 805 South Fairfax Street -------------------------------------------------------------------------------- (Street) Alexandria VA 22314 -------------------------------------------------------------------------------- (City) (State) (Zip) CENTRAL EUROPEIAN DISTRIBUTION CORP. (CEDC) -------------------------------------------------------------------------------- 2. Issuer Name and Ticket or Trading Symbol CEDC -------------------------------------------------------------------------------- 3. IRS Identification Number of reporting person, If and Entity (Voluntary) -------------------------------------------------------------------------------- 4. Statement for Month/Year 5/02 -------------------------------------------------------------------------------- 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
------------------------------------------------------------------------------------------------------------------------------------ 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 Page 1 of 2 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) of (D) Price of (Month/ (Instr. 3, 4 and 5) Deriv- Day/ ative Year) Security ----------------------------------------------------------------------------------------------------------------------------- Code V (A) (D) Director Stock Options $14.40 4/29/02 V(A) 1,500
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- cisable Underlying Securities of of Deriv- ship Beneficial (Instr. 3 and 4) Deriv- ative Form and ative Secur- of De- Expiration Secur- ities rivative Date Ownership ity Bene- Security: (Month/Day/ (Instr. ficially Direct (D) Year) (Instr. 4) 5) Owned or Indirect at End (I) (Instr. 4) of Month (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ Date Expira- Amount or Exer- tion Title Number of cisable Date Shares 4/29/02 4/29/12 Common 1,500 1,500 (D) Stock
(Print or Type Responses) (Form 4-07-98) (Over) Explanation of Responses: ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ James Grossmann 5/9/02 --------------------------------------- ----------------- **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. Page 2 of 2