/------------------------------/ / OMB APPROVAL / /------------------------------/ / OMB Number: 3235-0362 / / Expires: February 1, 1994 / / Estimated average burden / / hours per response...... 1.0 / /------------------------------/ +--------+ | FORM 5 | U. S. 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(1) of the Investment Company Act of 1940 [_] Form 3 Holdings Reported [_] Form 4 Transactions Reported -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person O'Dowd Joseph ---------------------------------------------------------------------------- (Last) (First) (Middle) c/o Lakeland Bancorp, Inc. 250 Oak Ridge Road ---------------------------------------------------------------------------- (Street) Oak Ridge New Jersey 07438 ---------------------------------------------------------------------------- (City) (State) (Zip) ---------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol Lakeland Bancorp, Inc. ---------------------------------------------------------------------------- 3. IRS or Social Security Number of Reporting Person (Voluntary) 150-32-9181 ---------------------------------------------------------------------------- 4. Statement for Month/Year 12/31/00 ---------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) Dec-99 ---------------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [_] 10% Owner [_] Officer [X] Other (Title below) (Specify below) 0.11% ------------------- ------------------------------------------------------------------------------- Table - 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- Day/ End of (D) or ficial Year) Issuer's Indirect Owner- Lakeland Bancorp Inc. ------------------------------ Fiscal Year (I) ship Amount (A) or (D) Price (Instr. 3 and 4) (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ Common 02/15/00 DRP 1 A $12.5000 D *1 ------------------------------------------------------------------------------------------------------------------------------------ Common 05/15/00 DRP 2 A $11.1190 D *1 ------------------------------------------------------------------------------------------------------------------------------------ Common 08/15/00 DRP 2 A $11.7140 D *1 ------------------------------------------------------------------------------------------------------------------------------------ Common 11/15/00 S/D 13 A $10.5360 D *1 ------------------------------------------------------------------------------------------------------------------------------------ Common 11/15/00 DRP 1 A $10.9258 276 D *1 ------------------------------------------------------------------------------------------------------------------------------------ Common 02/15/00 DRP 78 A $12.5000 I *2 ------------------------------------------------------------------------------------------------------------------------------------ Common 05/15/00 DRP 87 A $11.1190 I *2 ------------------------------------------------------------------------------------------------------------------------------------ Common 08/15/00 DRP 83 A $11.7140 I *2 ------------------------------------------------------------------------------------------------------------------------------------ Common 11/15/00 S/D 656 A $10.5360 I *2 ------------------------------------------------------------------------------------------------------------------------------------ Common 11/15/00 DRP 96 A $10.9258 13882 I *2 ------------------------------------------------------------------------------------------------------------------------------------ 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) J. O'Dowd ----------------------------------------------------------------------------------------------------------------------------- 1. Title of Derivative 2. Conversion or 3. Transaction 4. Transaction 5. Number of Derivative Security (Instr. 3) Exercise Price Date (Month/ Code (Instr. 8) Securities Acquired (A) of Derivative Day/Year) or Disposed of (D) Security (Instr. 3, 4, and 5) --------------------------- (A) (D) ----------------------------------------------------------------------------------------------------------------------------- Stock Option Right to Purchase 9.38 2/9/00 A 25,000 __ ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- * Stock Option was granted pursuant to Company's 2000 Equity Compensation program and vests in 20% annual installments beginning on the grant date ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ 6. Date Exercisable 7. Title and Amount of 8. Price of 9. Number of 10. Ownership 11. Nature and Expiration Underlying Securities Derivative Derivative of Derivative of Indirect Date (Month/Day/ (Instr. 3 and 4) Security Securities Security: Beneficial Year) (Instr. 5) Bene-ficially Direct (D) or Ownership Owned at End Indirect (1) (Instr. 4) of Year (Instr. 4) (Instr. 4) -------------------------------------------- Date Expira- Amount or Exer- tion Title Number of cisable Date Shares ------------------------------------------------------------------------------------------------------------------------------------ * 2/8/10 Common 25,000 --- 25,000 D --- ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: ------------------------ *1 - Solely owned by J. O'Dowd *2 - Owned by Joseph and Patricia O'Dowd, wife of Joseph CODES: DRP - Dividend Reinvestment Plan S/D - Stock Dividend ** 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. /s/ Joseph O'Dowd 1/12/00 -------------------------------- ----------------- **Signature of Reporting Person Date