4/A 1 d4a.txt AMENDMENT #1 TO FORM 4 FOR JEFFREY PETERSON ------------------------------ 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 (Amendment No. 1) 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 34239 -------------------------------------------------------------------------------- (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. If Amendment, Date of Original (Month/Year) 5/02 -------------------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [X] 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 Beneficialy Owned
6. 4. 5. Owner- Securities Acquired (A) or Amount of ship 3. Disposed of (D) Securities Form 7. Transaction (Instr. 3, 4 and E) Beneficially Direct Nature of 2. Code ------------------------------- owned at end (D) or Indirect 1. Transaction (Instr. B) (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 --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------
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)
5. Number of Derivative Securities Acquired 1. Title of Derivative 2. Conversion of Exercise 3. Transaction Date 4. Transaction (A) or Disposed or (D) Security (Instr. 3) Price of Derivative Security (Month/Day/Year) Code (Instr. 8) (Instr. 3, 4 and 5 -------------------------------------------------------------------------------------------------------------------------------- Code V (A) (D) Director Stock Options $14.40 4/29/02 V(A) 3,000
TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
10. Ownership Form of Nature of 7. Title and Derivative indirect Amount of 8. Price of 9. Number of Security: 6. Date Exercisable Underlying Derivative Derivative Securities Direct (D) or and Expiration Date Securities Security Beneficially Owned at Indirect (I) Ownership (Instr. 3 and 4) (Instr. 5) End of Month (Instr. 4) (Instr. 4) (Month/Day/Year) (Instr. 4) --------------------------------------------------------------------------------------------------------------------------- (D) Date Expiration Title Amount Exercisable Date or Number of Shares 4/29/02 4/29/12 Common 3,000 (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 06/14/02 ---------------------------------------- ----------------- ** 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 3