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OMB APPROVAL
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OMB Number: 3235-0104
Expires: September 30, 1998
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 3
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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
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1. Name and Address of Reporting Person*
Koninklijke Ahold N.V.
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(Last, First, Middle)
Albert Heijnweg 1
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(Street)
1507 EH Zaandam, The Netherlands
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(City, State, Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
April 14, 2000
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Issuer Name and Ticker or Trading Symbol
Peapod, Inc. (PPOD)
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5. 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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6. If Amendment, Date of Original (Month/Day/Year)
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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
5(b)(v).
<PAGE>
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Table I -- Non-Derivative Securities Beneficially Owned
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<TABLE>
<CAPTION>
3. Ownership Form:
2. Amount of Securities Direct (D) or
1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr.5)
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<S> <C> <C> <C>
(1)
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
<PAGE>
<TABLE>
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Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<CAPTION>
3. Title and Amount of Securities
Underlying Derivative Security
2. Date Exercisable (Instr. 4)
and Expiration Date ---------------------------------
(Month/Day/Year) Amount
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Date Expira- Number
1. Title of Derivative Exer- tion of
Security (Instr. 4) cisable Date Title Shares
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<S> <C> <C> <C> <C>
(1) Common Stock Purchase
Warrants Immed. April 9, 2010 Common Stock 100,000
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(2) Common Stock Purchase
Warrants Immed. April 13, 2010 Common Stock 3,566,667
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<PAGE>
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Table II (cont.) -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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5. Owner-
ship
Form of
Derivative
4. Conver- Security:
sion or Direct 6. Nature of
Exercise (D) or Indirect
Price of Indirect Beneficial
1. Title of Derivative Derivative (I) Ownership
Security (Instr. 4) Security (Instr.5) (Instr. 5)
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<S> <C> <C> <C>
(1) Common Stock Purchase
Warrants $3.00 D
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(2) Common Stock Purchase
Warrants $3.00 D
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</TABLE>
<PAGE>
Explanation of Responses:
In addition, pursuant to and subject to the terms and conditions set forth in
the Purchase Agreement dated as of April 14, 2000 between the Reporting Person
and the Issuer (including approval by the stockholders of the Issuer), the
Reporting Person has agreed to acquire (i) 726,371 shares of Series B
Convertible Preferred Stock (the "Shares") of the Issuer which would be
convertible into initially 19,369,873 shares of common stock of the Issuer (the
"Common Stock") at a conversion price of $3.75, and (ii) warrants (the "Warrant
(Preferred Stock)") to purchase initially 32,894,270 shares of Common Stock at
an exercise price of $3.75. Prior to the occurrence of the purchase of the
Shares and the Warrant (Preferred Stock), the Reporting Person expressly
disclaims beneficial ownership of the Shares, the Warrant (Preferred Stock) and
the shares of Common Stock which are purchasable by the Reporting Person upon
conversion of the Shares and exercise of the Warrants (Preferred Stock).
/s/ A.P.H.M. van Tielraden April 24, 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 provided is insufficient, see Instruction 6 for procedure.
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.
SEC 1473 (7-96)
