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* Blake Donald M. -------------------------------------------------------------------------------- (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) X Director ____ Officer ___ 10% Owner ___ Other ----- (give title below) (specify below) ---------------------------------------------------------------------------- 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 12/16/02 G 2,415 D ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 12/30/02 G 4,025 D ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 12/16/02 G 805 D 185,517 D ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 12/16/02 G 805 A 43,632 I By Wife ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 3,483 I Held in Keogh ------------------------------------------------------------------------------------------------------------------------------------ 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 $27.405 Common Stock (1) -------------------------------------------------------------------------------------------------------------------------- Option to Purchase $24.61 7/24/02 A 25,500 Common Stock (2) -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- 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) -------------------------------------------------------------------------------------------------------------------------- 7/24/02 1/24/12 Common 121,500 121,500 D Stock -------------------------------------------------------------------------------------------------------------------------- 7/24/03 7/24/12 Common 25,500 25,500 D Stock -------------------------------------------------------------------------------------------------------------------------- Explanation of Responses: (1) Options automatically granted pursuant to the reload feature of the New York Community Bancorp, Inc. ("NYCB") 1997 Stock Option Plan that were exercisable beginning on July 24, 2002. (2) Options granted under the NYCB 1997 Stock Option Plan that vest in three equal annual installments beginning on July 24, 2003. /s/ Ilene A. Angarola February 14, 2003 -------------------------------- -------------------- **Signature of Reporting Person Date By: Ilene A. Angarola, Power of Attorney For: Donald M. Blake ** 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. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. Page 2