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 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 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) UI. Bokserska 66a -------------------------------------------------------------------------------- (Street) Warsaw Poland 02-690 -------------------------------------------------------------------------------- (City) (State) (Zip) CENTRAL EUROPEAN DISTRIBUTION CORP. (CEDC) ------------------------------------------------------------------------------- 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 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
---------------------------------------------------------------------------------------------------------------------------- 4. 5. 6. Securities Acquired (A) Amount of Ownership 2. 3. or Disposed of (D) Securities Form: 1. Transaction Transaction (Instr. 3, 4 and 5) Beneficially Direct 7. Title of Security Date Code --------------------- Owned at End (D) or Nature of (Instr. 3) (mm/dd/yy) (Instr. 8) (A) of Month Indirect Indirect ----------- Amount or Price (Instr. 3 and 4) (I) Beneficial Code V (D) (Instr. 4) Ownership ---------------------------------------------------------------------------------------------------------------------------- CEDC Common Stock 4/30/01 M 1,500 A 3.79 D ---------------------------------------------------------------------------------------------------------------------------- CEDC Common Stock 5/13/02 S 1,500 D 16.20 0 ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------
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)
Derivate Acquired 1. Title of Derivative 2. Conver- 3. Trans- 4. Transac- 5. Number of Security (Instr. 3) sion of action tion Code Securities Exercise Date (Instr. 8) (A) or Disposed Price of (Month/ or (D) Deriv- Day/ (Instr. 3, 4, and 5) ative Year) Security ------------------------------------------------------------------------------------------------------------------------------------ Code V (A) (D) Director Stock Options 3.79 5/20/02 M (D) 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 Exercisable 7. Title and 8. Price of 9. Number of 10. Ownership Beneficial Amount of Derivative Derivative Securities Form of and Expiration Date Underlying Security Beneficial Owned at Derivative In- ownership Securities (Instr. 5) End of Month (Instr. 4) Security: (Month/Day/Year) (Instr. 3 and 4) Direct (D) or (Instr. 4) Indirect (I) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ (D) Date Expiration Title Amount Exercisable Date or Number of Shares April 30, 01 4/30/11 Common 1,500 0 (D) Stock
(Print or Type Responses) (Over) (Form 4-07/99) Explanation of Responses: ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Tony Housh 5/22/02 ---------------------------------------- ----------------- **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.