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FORM 5
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/ / Check box if no U.S. SECURITIES AND EXCHANGE COMMISSION -------------------------------
longer subject to WASHINGTON, DC 20549 OMB APPROVAL
Section 16. Form -------------------------------
4 or Form 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB Number: 3235-0362
obligations may Expires: April 30, 1997
continue. See Filed pursuant to Section 16(a) of the Securities Estimated average burden
Instruction 1(b) Exchange Act of 1934, hours per response.....1.0
/ / Form 3 Holdings Section 17(a) of the Public Utility -------------------------------
Reported Holding Company Act of 1935 or Section 30(f) of
/ / Form 4 the Investment Company Act
Transactions of 1940
Reported
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1. Name and Address of Reporting Person 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to
Carey Francis J. Carey Diversified LLC "CDC" Issuer (Check all applicable)
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(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- ---
Number of Reporting Month/Year x Officer (give Other (specify
485 Lewis Lane Person (Voluntary) 12/31/98 ---- title --- below)
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(Street) 5. If Amendment, Chief Executive Officer
Date of Original Chairman of the Board
Arbier PA 19002 (Month/Year)
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(City) (State) (ZIP) ----------------- (Check Applicable Line)
-- Form Filed by One Reporting Person
-- Form Filed by more than 1 Reporting
Person
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TABLE 1 -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature
(Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In-
Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct
(Instr. 8) End of Issuer's Direct Benefi-
(Month/ Fiscal Year (D) or cial
Day/ ---------------------------- (Instr. 3 and 4) Indirect Owner-
Year) Amount (A) or Price (I) ship
(D) (Instr. 4) (Instr.
4)
Listed Shares 12/31/98 A 7500 A D
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Listed Shares 8/31/98 P4 1507 A $19.90 27,080(1) D
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
(Print or Type Responses)
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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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1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price
Security sion or action action Derivative cisable and of Underlying of
(Instr. 3) Exercise Date Code Securities Ac- Expiration Securities Deriv-
Price of (Month/ (Instr. 8) quired (A) or Date (Instr. 3 and 4) ative
Deriv- Day/ Disposed of (D) (Month/Day/ Secur-
ative Year) (Instr. 3, 4, Year) ity
Security and 5) (Instr. 5)
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Date Expira- Amount or
--------------- Exer- tion Title Number of
(A) (D) cisable Date Shares
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Options $20 1/2/98 A 75,000 1/2/98 1/2/08 Listed Shares 75,000
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Options $20 1/2/98 A 38,500 1/2/98 1/2/08 Listed Shares 38,500
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1. Title of Derivative 9. Number of 10. Ownership 11. Nature of
Security Derivative of Derivative Indirect
(Instr. 3) Securities Security: Beneficial
Beneficially Direct (D) Ownership
Owned at End or Indirect (I) (Instr. 4)
of Year (Instr. 4)
(Instr. 4)
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Options 0
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Options 113,500 0
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Explanation of Responses:
(1) Includes 616 shares acquired in April, July and October 1998 under Carey Diversified LLC's dividend
reinvestment plan.
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Francis Carey 2/1/99
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ------------------------------- -------
**Signature of Reporting Person Date
Note. File three copies of this Form, one of which must be manually signed. Page 2
If space provided is insufficient, see Instruction 6 for procedure.
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