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OMB APPROVAL
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OMB Number 3235-0362
Expires: April 30, 1997
Estimated average burden
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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 5
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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(f) of the Investment Company Act of 1940
[ ] Check this box if no longer subject of Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
[ ] Form 3 Holdings Reported
[ ] Form 4 Transactions Reported
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1. Name and Address of Reporting Person
Verneuille, Janet T.
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(Last) (First) (Middle)
1103 Millstone Road
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(Street)
Sag Harbor, NY 11963
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Bridge Bancorp, Inc. BDGE
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Statement for Month/Year
12/01
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[ ] Director [ ] 10% Owner
[ X ] Officer (give title below) [ ] Other (specify below)
Senior Vice President and Comptroller
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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5. 6.
4. Amount of Owner-
Security Acquired (A) or Securities ship
Disposed of (D) Beneficially Form: 7.
(Instr. 3, 4 and 5) Owned at End Direct Nature of
2. 3. ----------------------------- of Issuer's (D) or Indirect
1. Transaction Transaction (A) Fiscal Year Indirect Beneficial
Title of Security Date Code Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) (Instr. 8) (D) & 4) (Instr.4) (Instr. 4)
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Common Stock 2,007 D
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Common Stock 114 I Husband
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Common Stock 395 D Self &
Husband JT
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Common Stock 28 D Self & Son
JT
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Common Stock 28 D Self &
Daughter
JT
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Common Stock 28 D Self &
Daughter
JT
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Common Stock (Restricted*#) 01/17/01 A 540 A $16.50 900 D
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*On January 24, 2000, 540 Shares were awarded under the Equity Incentive Plan,
of which, 180 vested on January 15, 2001 and 180 vesting on each anniversary
thereafter conditioned on continued service at the time of vesting. Of the 180
shares vested on January 15, 2001, 60 shares are included in the directly owned
common stock above, and an additional 120 shares are included in the
beneficially owned common stock above.
#On January 17, 2001, 540 Shares were awarded under the Equity Incentive Plan,
vesting 180 on January 17, 2002 and 180 on each anniversary thereafter
conditioned on continued service at the time of vesting.
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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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9. 10.
Number Owner-
of ship
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- Securities Date Securities Price Bene- ity: In-
cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date action (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship
Security Secur- Day/ (Instr. ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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Stock Options $16.50 01/17/01 A 1,500 1/17/01 1/17/11 Common Stock 1,500 7,500 D
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Explanation of Responses:
/s/ Janet T. Verneuille 01/17/02
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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. 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.