1 ================================================================================ /------------------------------/ / OMB APPROVAL / /------------------------------/ / OMB Number: 3235-0362 / / Expires: January 31, 2005 / / 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(h) of the Investment Company Act of 1940 [_] Form 3 Holdings Reported [_] Form 4 Transactions Reported (Print or Type Responses) -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Ricca Mark A. -------------------------------------------------------------------------------- (Last) (First) (Middle) 615 Merrick Avenue -------------------------------------------------------------------------------- (Street) Westbury NY 11590 -------------------------------------------------------------------------------- (City) (State) (Zip) 2. Issuer Name and Ticker or Trading Symbol New York Community Bancorp, Inc. ----------------------------------- (NYB) -------------------------------------------------------------------------------- 3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary) -------------------------------------------------------------------------------- 4. Statement for Month/Year December 2002 --------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) -------------------------------- 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) Director X Officer ___ 10% Owner ___ Other ----- ----- (give title below) (specify below) Executive VP, General Counsel & Corp. Sec'y ---------------------------------------------------------------------------- 7. Individual or Joint/Group Filing (Check Applicable Line) X Form filed by One Reporting Person --- ____ Form filed by More than One Reporting Person ------------------------------------------------------------------------------------------------------------------------------------ TABLE I--NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED ------------------------------------------------------------------------------------------------------------------------------------ 1. Title 2. Trans- 2A. 3. Trans- 4. Securities Acquired (A) 5. Amount of 6.Owner- 7. Nature of action Deemed action or Disposed of (D) Securities ship of In- Security Date Execution Code (Instr. 3, 4 and 5) Beneficially Form: direct (Instr. 3) (mm/dd/ Date, if (Instr. 8) Owned at the Direct Bene- yy) any ----------------------------------------------- End of Issuer's (D)or ficial (mm/dd/yy) Fiscal Year Indirect Owner- Code Amount (A) or Price (Instr. 3 and 4) (I) ship (D) (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 26,929 D ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 9,339 I By ESOP(1) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 5,234 I By NYCB 401(k)(2) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 6,059 I By CFS Bank 401(k)(3) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 780 I By Stock Incentive Plan(4) ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. *If the form is filed by more than one reporting person, see Instruction 4(b)(v). Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. (Over) SEC 2270(9-02) Page 1 2 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) -------------------------------------------------------------------------------------------------------------------------- Option to Purchase $11.06 Common Stock (5) -------------------------------------------------------------------------------------------------------------------------- Option to Purchase $15.37 Common Stock (5) -------------------------------------------------------------------------------------------------------------------------- Option to Purchase $15.37 Common Stock (5) -------------------------------------------------------------------------------------------------------------------------- Option to Purchase $15.37 Common Stock (5) -------------------------------------------------------------------------------------------------------------------------- Option to Purchase $22.23 Common Stock (6) -------------------------------------------------------------------------------------------------------------------------- Option to Purchase $24.61 7/24/02 A 30,000 Common Stock (7) -------------------------------------------------------------------------------------------------------------------------- Option to Purchase $28.54 Common Stock (8) -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- TABLE II--DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) -------------------------------------------------------------------------------------------------------------------------- 6. Date Exer- 7. Title and Amount of 8. Price 9. Number of 10. Owner- 11. Na- cisable and Underlying Securities of Deriv- ship ture Expiration (Instr. 3 and 4) Deriv- ative of De- of In- Date ative Secur- rivative direct (Month/Day/ Secur- ities Security: Bene- Year) ity Bene- Direct ficial (Instr. ficially (D) or Owner- ----------------------------------------------- 5) Owned Indirect (I) ship Date Expira- Amount or At End (Instr. 4) (Instr. 4) Exer- tion Title Number of of Year cisable Date Shares (Instr. 4) -------------------------------------------------------------------------------------------------------------------------- 11/30/00 2/23/08 Common 26,566 26,566 D Stock -------------------------------------------------------------------------------------------------------------------------- 1/18/02 1/18/10 Common 4,744 4,744 D Stock -------------------------------------------------------------------------------------------------------------------------- 1/18/03 1/18/10 Common 11,250 11,250 D Stock -------------------------------------------------------------------------------------------------------------------------- 1/18/04 1/18/10 Common 11,250 11,250 D Stock -------------------------------------------------------------------------------------------------------------------------- 12/21/02 12/21/11 Common 15,000 15,000 D Stock -------------------------------------------------------------------------------------------------------------------------- 7/24/03 7/24/12 Common 30,000 30,000 D Stock -------------------------------------------------------------------------------------------------------------------------- 1/21/04 1/21/13 Common 90,000 90,000 D Stock -------------------------------------------------------------------------------------------------------------------------- Explanation of Responses: (1) This form reflects increases in beneficial ownership resulting from exempt acquisitions under an Employee Stock Ownership Plan ("ESOP") pursuant to Rule 16b-3(c). (2) Includes shares rolled over from the CFS Bank ESOP to the New York Community Bank 401(k) Plan. Also includes increases in beneficial ownership resulting from exempt acquisitions under the 401(k) Plan pursuant to Rule 16b-3(c). For purposes of this report, units in the 401(k) plan have been converted into an approximate number of shares of New York Community Bancorp, Inc. ("NYCB") common stock. The actual number of shares held by the reporting person in this account may vary when such units are actually converted into shares upon distribution of the units to the reporting person. (3) Represents shares purchased through the CFS Bank 401(k) Plan, which New York Community Bank was successor to under the Haven Bancorp, Inc. acquisition. (4) Represents shares granted on February 15, 2002 under the Haven Bancorp, Inc. Stock Incentive Plan, which will vest on February 15, 2003. (5) Options to purchase shares granted under the Haven Bancorp, Inc. 1996 Stock Option Plan. (6) Options granted pursuant to the NYCB 1997 Stock Option Plan that vest in three equal annual installments beginning on December 21, 2002. (7) Options granted pursuant to the NYCB 1997 Stock Option Plan that vest in three equal annual installments beginning on July 24, 2003. (8) Options granted pursuant to the NYCB 1997 Stock Option Plan that vest in three equal annual installments beginning on January 21, 2004. /s/ Ilene A. Angarola February 14, 2003 -------------------------------- -------------------- **Signature of Reporting Person Date By: Ilene A. Angarola, Power of Attorney For: Mark A. Ricca ** Intentional misstatements or ommissions 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. 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