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OMB APPROVAL
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OMB Number 3235-0287
Expires: September 30, 1998
Estimated average burden
hours per response ....... 0.5
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UNITED STATES 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).
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1. Name and Address of Reporting Person*
Koninklijke Ahold N.V.
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(Last, First Middle)
Albert Heijnweb 1
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(Street)
1507 EH Zaandam, The Netherlands
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(City, State Zip)
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2. Issuer Name and Ticker or Trading Symbol
Peapod, Inc. (PPOD)
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Statement for Month/Year
October 2000
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
[ ] Director [ X ] 10% Owner
[ ] Officer (give title below) [ ] Other (specify below)
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7. Individual or Joint/Group Filing (Check applicable line)
[ X] Form filed by one Reporting Person
[ ] Form filed by more than one Reporting Person
* If the form is filed by more than one reporting person,
see Instruction 4(b)(v).
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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<TABLE>
<CAPTION>
4.
Securities Acquired (A) or
3. Disposed of (D)
Transaction (Instr. 3, 4 and 5)
2. Code -----------------------------
1. Transaction (Instr. 8) (A)
Title of Security Date ------------ Amount or Price
(Instr. 3) (mm/dd/yy) Code V (D)
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<S> <C> <C> <C> <C> <C> <C>
(1) Common Stock 10/06/00 P 2,331,917 A $1.125
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(2)
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(3)
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(4)
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(5)
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(6)
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(7)
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(8)
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(9)
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(10)
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(11)
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(12)
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(13)
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(14)
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(15)
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(16)
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(17)
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(18)
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(19)
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(20)
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(21)
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(22)
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(23)
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(24)
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(25)
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<PAGE>
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Table I (cont.) -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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5. 6. Owner-
Amount of ship
Securities Form: 7.
Beneficially Direct Nature of
Owned at End (D) or Indirect
1. of Month Indirect Beneficial
Title of Security (Instr. 3 (I) Ownership
(Instr. 3) and 4) (Instr.4) (Instr. 4)
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<S> <C> <C> <C>
(1) Common Stock 2,331,917 D
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(2)
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(3)
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(4)
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(5)
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(6)
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(7)
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(8)
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(9)
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(10)
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(11)
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(12)
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(13)
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(14)
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(15)
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(16)
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(17)
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(18)
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(19)
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(20)
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(21)
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(22)
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(23)
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(24)
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(25)
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
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Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
6.
Date
5. Exercisable and
2. 4. Number of Derivative Expiration Date
1. Conversion or Transaction Securities Acquired (A) (Month/Day/Year)
Title of Exercise 3. Code or Disposed of (D) ----------------
Derivative Price of Transaction (Instr. 8) (Instr. 3, 4 and 5) Date Expira-
Security Derivative Date (Month/ ------ ----------------------- Exer- tion
(Instr. 3) Security Day/Year) Code V (A) (D) cisable Date
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<S> <C> <C> <C> <C> <C> <C> <C> <C>
(1) Series B $3.75 10/12/00 S 726,371 Immed N/A
Convertible
Preferred Stock
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(2) Series C $3.75 10/12/00 P 726,371 Immed N/A
Convertible
Preferred Stock
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(3)
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(4)
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(5)
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(6)
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(7)
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(8)
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(9)
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(10)
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(11)
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(12)
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(13)
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(14)
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(15)
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(16)
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(17)
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(18)
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(19)
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(20)
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(21)
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(22)
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(23)
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(24)
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(25)
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<PAGE>
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Table II (cont.) -- Derivative Securities Acquired, Disposed of, or Beneficially
Owned (e.g., puts, calls, warrants, options, convertible securities)
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7.
Title and Amount
of Underlying
Securities 9. 10.
(Instr. 3 and 4) Number of Ownership
---------------- Derivative Form of 11.
1. Amount 8. Securities Derivative Nature of
Title of or Price of Beneficially Security: Indirect
Derivative Number Derivative Owned Direct (D) Beneficial
Security of Security at End of Month or Indirect Ownership
(Instr. 3) Title Shares (Instr. 5) (Instr.4) (I) (Instr. 4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C>
(1) Series B Common Stock 19,369,873 726,371 Shares 726,371 D
Convertible of Series C
Preferred Stock Convertible
Preferred Stock.
See explanation
of response.
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(2) Series C Common Stock 19,369,873 726,371 Shares 726,371 D
Convertible of Series B
Preferred Stock Convertible
Preferred Stock.
See explanation
of response.
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(3)
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(4)
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(5)
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(6)
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(7)
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(8)
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(9)
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(10)
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(11)
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(12)
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(13)
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(14)
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(15)
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(16)
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(17)
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(18)
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(19)
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(20)
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(21)
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(22)
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(23)
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(24)
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(25)
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</TABLE>
<PAGE>
Explanation of Responses:
The 726,371 shares of Series B Convertible Preferred Stock together with the
Warrants (Preferred Stock) to purchase 32,894,270 shares of Common Stock at an
Exercise price of $3.75 were valued at $72,637,024 under the Purchase Agreement
dated as of April 14, 2000 between the Reporting Person and the Issuer. The same
value is attributable to the 726,371 shares of Series C Convertible Preferred
Stock.
/s/ A.H.P.M. van Tielraden November 1, 2000
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**Signature of Reporting Person Date
** Intentional misstatements or omissions of facts constitute Federal
Criminal Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed.
If space is insufficient, see Instruction 6 for procedures.
Potential persons who are to respond to the collection of information contained
in this form are not required to respond unless the form displays a currently
valid OMB number.
