-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, SSIS0kMSY5l56SC53/Ghq4Um5fVrsAs9DAdZN2C5ZuiV165yOhrKTnxwLqUOQ9sX 2b0lyZuFQr3OKC4MKzfPqQ== 0000950130-00-000360.txt : 20000203 0000950130-00-000360.hdr.sgml : 20000203 ACCESSION NUMBER: 0000950130-00-000360 CONFORMED SUBMISSION TYPE: 5/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991231 FILED AS OF DATE: 20000202 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: LAKELAND BANCORP INC CENTRAL INDEX KEY: 0000846901 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] IRS NUMBER: 222953275 STATE OF INCORPORATION: NJ FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5/A SEC ACT: SEC FILE NUMBER: 000-17820 FILM NUMBER: 520115 BUSINESS ADDRESS: STREET 1: 250 OAK RIDGE RD CITY: OAK RIDGE STATE: NJ ZIP: 07438 BUSINESS PHONE: 9736972000 MAIL ADDRESS: STREET 1: 250 OAK RIDGE RD CITY: OAKRIDGE STATE: NJ ZIP: 07438 COMPANY DATA: COMPANY CONFORMED NAME: FREDERICKS JOHN W CENTRAL INDEX KEY: 0000903399 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 5/A BUSINESS ADDRESS: STREET 1: C/O LAKELAND BANK STREET 2: 250 OAK RIDGE RD CITY: OAK RIDGE STATE: NJ ZIP: 07438 BUSINESS PHONE: 9736972000 MAIL ADDRESS: STREET 1: C/O LAKELAND BANK STREET 2: 250 OAK RIDGE RD CITY: OAK RIDGE STATE: NJ ZIP: 07438 5/A 1 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP FORM 5 /------------------------------/ / OMB APPROVAL / /------------------------------/ / OMB Number 3235-0362 / / Expires: February 1, 1994 / / Estimated average burden / / hours per response...... 1.0 / /------------------------------/ +--------+ UNITED STATES | FORM 5 | SECURITIES AND EXCHANGE COMMISSION +--------+ Washington, D.C. 20549 [_] Check box if no longer subject ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP to Section 16. Form 4 or Form 5 Filed pursuant to Section 16(a) of the Securities obligations may Exchange Act of 1934, Section 17(a) of the continue. See Public Utility Holding Company Act of 1935 or Instruction 1(b). Section 30(f) of the Investment Company Act of 1940 [_] Form 3 Holdings Reported [_] Form 4 Transactions Reported - -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person FREDERICKS JOHN W - -------------------------------------------------------------------------------- (Last) (First) (Middle) C/O LAKELAND BANCORP, INC. 250 OAK RIDGE ROAD - -------------------------------------------------------------------------------- (Street) OAK RIDGE NJ 07438 - -------------------------------------------------------------------------------- (City) (State) (Zip) 2. Issuer Name and Ticker or Trading Symbol LAKELAND BANKCORP, INC. ----------------------------------- 3. IRS or Social Security Number of Reporting Person (Voluntary) ###-##-#### -------------- 4. Statement for Month/Year 12/99 --------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) 12/98 -------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [ ] Officer [ ] 10% Owner [ ] Other (give title below) (specify below) 3.78% CHAIRMAN OF THE BOARD --------------------- - ------------------------------------------------------------------------------- Table I--Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
- ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature (Instr. 3) action action or Disposed of (D) Securities ship of In- Date Code (Instr. 3, 4 and 5) Beneficially Form: direct (Month/ (Instr. 8) Owned at Direct Bene- LAKELAND BANCORP, INC. Day/ End of (D) or ficial Year) Issuer's Indirect Owner- (A) or Fiscal Year (I) ship Amount (D) Price (Instr. 3 and 4) (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ COMMON 8/2/99 G 150 D N/K D *1 - ------------------------------------------------------------------------------------------------------------------------------------ COMMON 10/15/99 G 2,200 D N/K 133,042 D *1 - ------------------------------------------------------------------------------------------------------------------------------------ COMMON 7/15/99 J 9,600 A 15.50 127,594 I *2 - ------------------------------------------------------------------------------------------------------------------------------------ COMMON 97,996 I *3 - ------------------------------------------------------------------------------------------------------------------------------------ COMMON 2/15/99 DRP 465 A 19.00 I *4 - ------------------------------------------------------------------------------------------------------------------------------------ COMMON 5/14/99 DRP 499 A 17.75 I *4 - ------------------------------------------------------------------------------------------------------------------------------------ COMMON 8/19/99 DRP 599 A 14.87 119,379 I *4 - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------
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)
- ----------------------------------------------------------------------------------------------------------------------------- 1. Title of Derivative 2. Conver- 3. Trans- 4. Transac- 5. Number of Deriv- Security (Instr. 3) sion or action tion Code ative Securities Exercise Date (Instr. 8) Acquired (A) or Price of (Month/ Disposed of (D) Deriv- Day/ (Instr. 3, 4, and 5) ative Year) Security --------------------------- (A) (D) - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - -----------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------ 6. Date Exer- 7. Title and Amount of 8. Price 9. Number 10. Owner- 11. Na- cisable and Underlying Securities of of Deriv- ship ture Expiration (Instr. 3 and 4) Deriv- ative of De- of In- Date ative Secur- rivative direct (Month/Day/ Secur- ities Secu- Bene- Year) ity Bene- rity: ficial (Instr. 5) ficially Direct Owner- -------------------------------------------- Owned (D) or ship Date Expira- Amount or at End Indi- (Instr. 4) Exer- tion Title Number of of Year rect (I) cisable Date Shares (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses: G -- Gifted J -- Acquired thru merger of High Point with Lakeland DRP -- Dividend Reinvestment Plan *1 Owned solely by John W. Fredericks *2 Owned solely by Jane D. Fredericks, wife of John W. Fredericks *3 Owned by Edward J. Fredericks & John W. Fredericks U/W of Wilbur Fredericks *4 Owned by John W. Fredericks, Jane D. Fredericks, Tr. for Fredericks Fuel & Heating -------------------------------- ----------------- **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. -----END PRIVACY-ENHANCED MESSAGE-----