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FORM 5 U.S. SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL
------ Washington, D.C. 20549 =========================
OMB Number: 3235-0362
ANNUAL STATEMENT OF CHANGES IN Expires: February 1, 1994
BENEFICIAL OWNERSHIP Estimated average burden
hours per response...1.0
[_] Check box if no longer subject to Section 16. -------------------------
Form 4 or Form 5 obligations may continue.
See instruction 1(b).
[_] Form 3 Holdings Reported
[_] Form 4 Transactions Reported
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(1) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Fredericks John W.
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(Last) (First) (Middle)
c/o Lakeland Bancorp, Inc.
250 Oak Ridge Road
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(Street)
Oak Ridge New Jersey 07438
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(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol:
Lakeland Bancorp, Inc.
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3. IRS or Social Security Number of Reporting Person (Voluntary):
142-30-8575
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4. Statement for Month/Year:
12/31/00
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5. If Amendment, Date of Original (Month/Year):
Dec-99
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6. Relationship of Reporting Person to Issuer (Check all applicable):
_X_ Director ___ 10% Owner ___ Officer _X_ Other
(Title Below) (Specify Below)
3.75%
Chairman
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TABLE 1 - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF,
OR BENEFICIALLY OWNED
5. Amount of
4. Securities Acquired (A) Securities Bene- 7. Nature of
2. Trans- 3. Trans- or Disposed of (D) (Instr. ficially Owned at 6. Ownership Indirect
Title of action Date action 3, 4, and 5) End of Issuer's Form: Direct Beneficial
Security (Month/Day/ Code ------------------------------ Fiscal Year (D) or Indirect Ownership
(Instr. 3) Year) (Instr. 8) Amount (A) or (D) Price (Instr. 3 & 4) (I) (Instr. 4) (Instr. 4)
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Lakeland Bancorp, Inc.
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Common 06/06/00 G 20 D N/K D *1
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08/09/00 G 200 D N/K D *1
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11/15/00 S/D 6641 A $10.5360 D *1
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11/08/00 G 2750 D N/K 136713 D *1
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Common 11/15/00 S/D 6379 A $10.5360 133973 I *2
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Common 11/15/00 S/D 4899 A $10.5360 102895 I *3
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11/15/00 S/D 5968 A $10.5360 125347 I *4
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Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
FORM 5 (Continued)
Table II - Derivative Securities Acquired, Disposed of,
or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exercisable and 7. Title and Amount of
Security (Instr. 3) sion or action Date action Code Derivative Sec- Expiration Date Underlying Securities
Exercise (Month/ (Instr. 8) urities Acquired (Month/Day/Year) (Instr. 3 & 4)
Price of Day/Year) (A) or Disposed
Derivative (D) (Instr. 3, 4
Security & 5)
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Date Expiration Amount or
(A) (D) Exercisable Date Title Number of
Shares
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Stock Option Right
to Purchase 9.380 2/9/00 A 25,000 -- 2/8/10 * Common 25,000
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1. Title of Derivative 8. Price of 9. Number of Derivative 10. Ownership of 11. Nature of
Security (Instr. 3) Derivative Securities Beneficially Derivative Sec- Indirect Bene-
Securities Owned at End of Year urity: Direct (D) ficial Ownership
(Instr. 5) (Instr. 4) or Indirect (I) (Instr. 4)
(Instr. 4)
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Stock Option Right
to Purchase -- 25,000 D --
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* Stock Option was granted pursuant to Company's 2000 Equity Compensation
Program and vests in 20% annual installments beginning on grant date.
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Explanation of Responses:
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CODES: S/D - Stock Dividend
G - Gifted
*1 - Solely owned by J. Fredericks
*2 - Solely owned by Jane Fredericks, wife of John W. Fredericks
*3 - Owned by Edward J. Fredericks & John W. Fredericks Trustees u/w of
Wilbur Fredericks
*4 - Owned by John W. Fredericks, Jane D. Fredericks, Mark J. Fredericks,
Trustees of Fredericks Fuel and Heating Service Employees'
Profit Sharing Plan
/s/ John Fredericks 1/28/01
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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. 7811(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.