SEC Form 5
FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL 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).
  
Form 3 Holdings Reported.
  
Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
LEE JOHN W

(Last) (First) (Middle)
807 CARRIAGE COURT

(Street)
AUGUSTA GA 30909

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
GEORGIA CAROLINA BANCSHARES INC [ GECR ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/31/2003
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 at end of Issuer's Fiscal Year (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Amount (A) or (D) Price
Common Stock, $.001 par value 10/27/2003 G(1) 11,040(2) D (4) 0 D
Common Stock, $.001 par value 10/27/2003 G(1) 11,040(2) A (4) 0 I By LLLP
Common Stock, $.001 par value 10/27/2003 G 0(3) D (4) 109,460(2) I By LLLP
Common Stock, $.001 par value 08/08/1998(5)(7) P(7) 0(7) A (7) 262(2)(7) D
Common Stock, $.001 par value 08/08/1998(5)(6) P(6) 0(6) A (6) 10,212(6) I By IRA(6)
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)
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. Transfer of shares to Leeward Group, LLLP, a limited partnership of which the reporting person is the sole limited partner and of which the reporting person and his immediate family are the sole general partners.
2. The amount of shares beneficially owned has been adjusted to give effect to the 2 for 1 stock split effected on January 30, 2004.
3. Represents separate gifts of general partnership interest to three individuals. One gift represents a 49% interest in the limited partnership and two gifts represent a 1% interest in the limited partnership. The reporting person disclaims beneficial ownership of Georgia-Carolona Bancshares, Inc. stock held by the limited partnership except to the extent of his pecuniary interest therein.
4. Not Applicable.
5. Dummy entry as required by software error.
6. This row reflects indirect ownership which has not changed as a result of the transactions reported on this form.
7. This row reflects direct ownership which has not changes as a result of the transactions reported on this form.
James M. Thomas, Attorney-in-Fact 02/16/2004
** 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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.