/------------------------------/ / 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. 20551 [_] 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(l) of the Investment Company Act of 1942 [_] Form 3 Holdings Reported [_] Form 4 Transactions Reported -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person Zande Arthur L ---------------------------------------------------------------------------- (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 Bancorp, Inc. -- LBAI ----------------------------------- 3. IRS or Social Security Number of Reporting Person (Voluntary) 144-24-3589 --------------- 4. Statement for Month/Year December-2000 --------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) December-1999 -------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [X] Officer [_] 10% Owner [X] Other (give title below) (specify below) 0.18% President of Lakeland Bank ----------------------------------------------------------- -------------------------------------------------------------------------------- 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 (MM/ (Instr. 8) Owned at Direct Bene- DD/YY) End of (D) or ficial Lakeland Bancorp, Inc. Issuer's Indirect Owner- (A) or Fiscal Year (I) ship Amount (D) Price (Instr. 3 and 4) (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ Common 02/15/00 DRP 120 A $ 12.5000 D *1 ------------------------------------------------------------------------------------------------------------------------------------ 05/15/00 DRP 136 A $ 11.1190 D *1 ------------------------------------------------------------------------------------------------------------------------------------ 08/15/00 DRP 130 A $ 11.7140 D *1 ------------------------------------------------------------------------------------------------------------------------------------ 11/15/00 S/D 1,021 A $ 10.5360 D *1 ------------------------------------------------------------------------------------------------------------------------------------ 11/15/00 DRP 150 A $ 10.9258 21,599 D *1 ------------------------------------------------------------------------------------------------------------------------------------ 02/15/00 DRP 12 A $ 12.5000 I *2 ------------------------------------------------------------------------------------------------------------------------------------ 05/15/00 DRP 15 A $ 11.1190 I *2 ------------------------------------------------------------------------------------------------------------------------------------ 08/15/00 DRP 13 A $ 11.7140 I *2 ------------------------------------------------------------------------------------------------------------------------------------ 11/15/00 S/D 78 A $ 10.5360 I *2 ------------------------------------------------------------------------------------------------------------------------------------ 11/15/00 DRP 44 A $ 10.9258 2,242 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) ----------------------------------------------------------------------------------------------------------------------------- 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) ----------------------------------------------------------------------------------------------------------------------------- Stock Option Right to Purchase $ 9.380 A A 5,000 -- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------ 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 (1) cisable Date Shares (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ * 2/18/10 Common 5,000 -- 5,000 D -- ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ *Stock Option was pursuant to company's 2000 Equity Compensation Plan. First option 2/9/0125% beginning one year from 2/9/00. ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: *1 Solely owned b Arthur Zande *2 Solely owned by Nancy Zande, wife of Arthur Zande --------------------------------- CODES --------------------------------- DRP Dividend Reinvestment Plan --------------------------------- S/D Stock Dividend --------------------------------- S/O Stock Option --------------------------------- T Transfer --------------------------------- VP Voluntary Purchase --------------------------------- P Purchase --------------------------------- PM Purchase Market --------------------------------- /s/ [ILLEGIBLE]^^ 1/31/01 -------------------------------- ----------------- **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