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Previous: LOEWEN GROUP INC, 5, 2000-02-04 |
Next: LOEWEN GROUP INC, 5, 2000-02-04 |
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<CAPTION>
- ---------------- 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) |
|NAKAGAWA Daniel N. |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)|
| 4126 Norland Avenue | (Voluntary) | | |
| | | 12/31/1999 | President, Loewen Life Group |
| | | | Inc. |
|----------------------------------------| |------------------------|----------------------------------------|
| (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) | | |
|-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------|
|<S> |<C> |<C> |<C> |<C> |<C> |<C> |<C> |<C> |
| | | | | | | | | |
| | | | | | | | | |
|-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------|
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|-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------|
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|-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------|
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|-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------|
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|-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------|
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|-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------|
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|-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------|
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|-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------|
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|-------------------------------|------------|---------|----------------|----|---------|-----------------|----|--------------------|
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- ------------------------------------------------------------------------------------------------------------------------------------
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
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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) | |
|----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------|
|<S> |<C> |<C> |<C> |<C> |<C> |<C> |<C> |<C> |<C> |<C> |<C> |<C> |<C> |
|Calls | $24.6471| | J | | 500| | |Common Sto| 500| $24.6471 | 0| D | |
| | | | | | | | |ck | | | | | |
| | | | | | | | | | | | | | |
| | | (01)| (01) | | | (01)| (01)| | | | | | |
|----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------|
|Common sha| $.6100|11/30| I | 6176.0278| | | |Common Sto| 6176.0278| $0.6100 | 6176.0278| I |TLGI Fund |
|res | | 1999| | | | | |ck | | | | | |
| | | | | | | | | | | | | | |
| | (02)| | | | | (03)| (03)| | | (02)| | | |
|----------|---------|-----|---------|----------|----------|-----|-----|----------|----------|----------|----------|----|----------|
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- ------------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses:
(01) Withdrew entitlement to purchase 500 common shares pursuant to employee Share Purchase Plan.
(02) Canadian Funds
(03) Under The Loewen Group Inc. Group Retirement Saving Plan, the reporting person invests in the Trust Fund. The Trust Fund
invests primarily in common shares but also maintains cash reserves. The Trust Fund operates as a pooled fund. No com
mon 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 shares 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
NAKAGAWA, Daniel N. The Loewen Group Inc. 12/31/1999 PAGE: 2 OF 2
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