SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
WELCH M SCOTT

(Last) (First) (Middle)
6 LONGWOOD CT.

(Street)
ELKHART IN 46516

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
LAKELAND FINANCIAL CORP [ LKFN ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
07/14/2004
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. 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 of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Options (Right to buy) $13.5 06/13/2005 06/13/2010 Common Stock 500 500 D
Stock Options (Right to buy) $13.625 01/09/2006 01/09/2011 Common Stock 1,000 1,000 D
Stock Options (Right to buy) $15.125 02/08/2005 02/08/2010 Common Stock 600 600 D
Stock Options (Right to buy) $19.4375 02/09/2004 02/09/2009 Common Stock 575 575 D
Stock Options (Right to buy) $34.37 12/09/2008 12/09/2013 Common Stock 500 500 D
Phantom Stock $0 01/01/2003 01/01/2003 Common Stock 2,084.9 2,084.9 D
Phantom Stock $0 01/07/2003 01/07/2013 Common Stock 297.3 297.3 D
Phantom Stock $0 01/28/2003 01/28/2013 Common Stock 17.3 17.3 D
Phantom Stock $0 04/28/2003 04/28/2013 Common Stock 16.5 16.5 D
Phantom Stock $0 07/10/2003 07/10/2013 Common Stock 238 238 D
Phantom Stock $0 07/30/2003 07/30/2013 Common Stock 14 14 D
Phantom Stock $0 10/27/2003 10/27/2013 Common Stock 15 15 D
Phantom Stock $0 01/16/2004 01/16/2014 Common Stock 233 233 D
Phantom Stock $0 01/26/2004 01/26/2014 Common Stock 13 13 D
Phantom Stock $0 04/28/2004 04/28/2014 Common Stock 19 19 D
Phantom Stock $0(1) 07/14/2004 A 281 07/14/2004(2) 07/14/2014(3) Common Stock 281 $32.35 281 D
Explanation of Responses:
1. Each phantom stock unit exersises into 1 share of Common Stock.
2. Phantom stock is exercisable after the directors' retirement as a Board member.
3. Phantom shares expire after the directors' retirement as a Board member.
Teresa A. Bartman, Attorney-in-Fact 07/15/2004
** Signature of Reporting Person Date
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).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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