-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, WDrUC/XTMbjGqFp9T8o0eWI9/d597CB8qUj85hE9Xbbr1PP37GpIctC9q+8fg3Cy yFiVY8w3ggVU00YxM1LYwQ== 0001027907-00-000003.txt : 20000207 0001027907-00-000003.hdr.sgml : 20000207 ACCESSION NUMBER: 0001027907-00-000003 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000204 FILED AS OF DATE: 20000204 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: LOEWEN GROUP INC CENTRAL INDEX KEY: 0000845577 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PERSONAL SERVICES [7200] IRS NUMBER: 980121376 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 001-12163 FILM NUMBER: 523820 BUSINESS ADDRESS: STREET 1: 4126 NORLAND AVE CITY: BURNABY BC CANADA V5 STATE: A1 ZIP: V5G 3S8 BUSINESS PHONE: 6042999321 MAIL ADDRESS: STREET 1: 4126 NORLAND AVE STREET 2: BRITISH COLUMIA CITY: BURNABY V5G 3S8 STATE: A1 COMPANY DATA: COMPANY CONFORMED NAME: WEEDON MICHAEL GARTH CENTRAL INDEX KEY: 0001050029 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: C/O THE LOEWEN GROUP INC STREET 2: 4126 NORLAND AVE V5G 3S8 CITY: BURNABY CANADA BUSINESS PHONE: 6042999321 MAIL ADDRESS: STREET 1: C/O LOEWEN GROUP INC STREET 2: 4126 NORLAND AVE V5G 3S8 CITY: BURNABY CANADA 5 1
- ---------------- U.S. SECURITIES AND EXCHANGE COMMISSION ---------------------------- |F O R M 5| Washington, D.C. 20549 | OMB APPROVAL | - ---------------- |--------------------------| Check this box if ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP |OMB Number 3235-0362| [ ] no longer Subject |Expires: September 30,1998| to Section 16. |Estimated ave. burden | |hours per response.....1.0| [ ] Form 3 Holdings Rep. 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 [ ] Form 4 Trans. Rep. Section 30(f) of the Investment Company Act 1940 - ------------------------------------------------------------------------------------------------------------------------------------ |1.Name and Address of Reporting Person* |2.Issuer Name and Ticker or Trading Symbol |6.Relationship of Reporting Person to | | | | Issuer (Check all Applicable) | |WEEDON Michael G. |The Loewen Group Inc. | | | | (lwn) | | | | | Director 10% Owner | |----------------------------------------|------------------------------------------------|--- --- | | (Last) (First) (MI)|3.IRS or Soc. Sec. No. |4.Statement for Month/ | X Officer Other | | | of Reporting Person | Year |---(give title below) ---(Specify below)| | c/o The Loewen Group Inc. | (Voluntary) | | | | 4126 Norland Avenue | | 12/31/1999 | Executive Vice President | | | | | Operations & Chief Admin. Off. | |----------------------------------------| |------------------------|----------------------------------------| | (Street) | |5.If Amendment, Date of |7. Individual or Joint/Group Filing | | | | Original (Month/Year) | (Check Applicable Line) | | | | | | |Burnaby BC V5G -3S8 | | | X Form filed by One Reporting Person | | | | |--- | | | | | Form filed by More than One | | | | |--- Reporting Person | |----------------------------------------------------------------------------------------------------------------------------------| | (City) (State) (Zip) | | TABLE I - Non-Derivative Securities Acquired, Disposed of or Beneficially Owned | |----------------------------------------------------------------------------------------------------------------------------------| |1.Title of Security |2.Transac- |3.Trans. |4.Security Acquired (A) or |5.Amount of |6. |7.Nature of Indirect| | (Instr. 3) | tion Date | Code | Disposed of (D) | Securities |Own.| Beneficial | | |(Mon/Day/Yr)|(Instr.8)| (Instr. 3, 4 & 5) | Beneficially |Form| Ownership | | | | | | Owned at End of|(D) | (Instr. 4) | | | | |-------------------------------| Issuer's |or | | | | | | |(A) | | Fiscal Year |(I) | | | | | | Amount |(D) | Price | (Instr. 3 & 4) | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | |-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class securities owned directly or indirectly. SEC 2270 (7-96) *If the form is filed by more than one reporting person, see Instruction 4(b)(v). PAGE: 1 OF 2
FORM 5 (continued) TABLE II - Derivative Securities Acquired, Disposed of, Beneficially Owned (e.g., puts, calls, warrants, options, convertible security) - ------------------------------------------------------------------------------------------------------------------------------------ |1.Title of|2.Conver-|3. |4.Tran- |5.Number of |6.Date |7.Title and Amount |8.Price of|9.Number |10. |11.Nature | |Derivative|sion or |Trans| saction| Derivative |Exercisable| of Underlying |Derivative| of |Own.| of | |Security |Exercise |Date | Code | Securities |and | Securities |Security |Derivative|Form|Indirect | |(Instr. 3)|Price of |(Mon/|(Instr.8)| Acquired (A) or |Expiration | (Instr. 3 & 4) |(Instr. 5)|Securities|of |Beneficial| | |Deriva- | Day/| | Disposed of (D) |Date | | |Benefi- |Deri|Ownership | | |tive |Year)| | (Instr. 3, 4 & 5) |(Month/Day/| | |cially |Sec.|(Instr. 4)| | |Security | | | | Year) | | |Owned at |Dir.| | | | | | | |-----------|---------------------| |End of |(D) | | | | | | | | | | |Amount or | |Year |or | | | | | | |---------------------|Date |Exp. | Title |Number of | |(Instr. 4)|Ind.| | | | | | | (A) | (D) |Exbl.|Date | |Shares | | |(I) | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | |TLGI Fund | $.6100|11/30| I | 5342.4233| | | |Common Sto| 5342.4233| $0.6100 | 5342.4233| I |TLGI Fund | | | | 1999| | | | | |ck | | | | | | | | | | | | | | | | | | | | | | | (01)| | | | | (02)| (02)| | | (01)| | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (01) Canadian dollars. (02) Under The Loewen Group Inc. Group Retirement Savings Plan, the reporting person invests in the Trust Fund. The Trust Fu nd invests primarily in Common shares, but also maintains cash reserves. The Trust Fund operates as a pooled fund. No Common shares are allocated to individual participants' accounts, and distributions are made entirely in cash. Based on the reporting person's investment in the Trust Fund, and the Common share price at 11/30/99. **Intentional misstatements or omissions of facts constitute Federal /s/Bradley D. Stam 02/04/2000 Criminal Violations. 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. If space provided is insufficient, see Instruction 6 for procedure. SEC 2270 (7-96) 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 OMD Number WEEDON, Michael G. The Loewen Group Inc. 12/31/1999 PAGE: 2 OF 2
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