-----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, LUtMnd4wY0quoRY3ckaksNrsy0805vSMvahkrY/or94lS3AX2WX2c5QeZz1CBDbl nQE5MGXHWrC3E/Yfpt2+VQ== /in/edgar/work/20000725/0001028269-00-000087/0001028269-00-000087.txt : 20000921 0001028269-00-000087.hdr.sgml : 20000921 ACCESSION NUMBER: 0001028269-00-000087 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000531 FILED AS OF DATE: 20000725 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: NORTHWEST GOLD INC CENTRAL INDEX KEY: 0000352447 STANDARD INDUSTRIAL CLASSIFICATION: [1040 ] IRS NUMBER: 810384984 STATE OF INCORPORATION: WY FISCAL YEAR END: 0531 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 000-10229 FILM NUMBER: 678459 BUSINESS ADDRESS: STREET 1: 877 N 8TH WEST STREET 2: GLEN L LARSEN BLDG MINERALS PLZ CITY: RIVERTON STATE: WY ZIP: 82501 BUSINESS PHONE: 3078569278 MAIL ADDRESS: STREET 1: 877 NORTH 8TH WEST CITY: RIVERTON STATE: WY ZIP: 82501 COMPANY DATA: COMPANY CONFORMED NAME: US ENERGY CORP CENTRAL INDEX KEY: 0000101594 STANDARD INDUSTRIAL CLASSIFICATION: [1000 ]OWNER IRS NUMBER: 830205516 STATE OF INCORPORATION: WY FISCAL YEAR END: 0531 FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 877 NORTH 8TH WEST STREET 2: GLEN L LARSEN BLDG CITY: RIVERTON STATE: WY ZIP: 82501 BUSINESS PHONE: 3078569271 MAIL ADDRESS: STREET 1: 877 NORTH 8TH WEST CITY: RIVERTON STATE: WY ZIP: 82501 FORMER COMPANY: FORMER CONFORMED NAME: WESTERN STATES MINING INC DATE OF NAME CHANGE: 19851229 5 1 0001.txt FORM 5 - MAY 31, 2000 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ( ) Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instructions 1(b). ( ) Form 3 Holdings Reported (X) Form 4 Transactions Reported 1. Name and Address of Reporting Person U.S. ENERGY, CORP. 877 NORTH 8TH WEST RIVERTON, WY 82501 USA 2. Issuer Name and Ticker or Trading Symbol NORTHWEST GOLD, INC. NWG 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year MAY 31, 2000 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) ( ) Director (X) 10% Owner ( ) Officer (give title below) ( ) Other (specify below) 7. Individual or Joint/Group Reporting (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 |2. |3. |4.Securities Acquired (A) |5.Amount of |6.Dir |7.Nature of Indirect | |Transaction| or Disposed of (D) | Securities |ect | Beneficial Ownership | |Date |Code| | Beneficially |(D)or | | | | | | A/| | Owned at |Indir | | | | | Amount | D | Price | End of Year |ect(I)| | ___________________________________________________________________________________________________________________________________| $.001 Par Value Common St|09/07/|J-4(|23,202,500 |A |NIL |25,242,500 |D | | ock |99 |a) | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| $.001 Par Value Common St|04/03/|J-4(|24,990,075 |D |NIL |252,425 |D | | ock |00 |b) | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| $.001 Par Value Common St|05/31/|J-4(|7,309,794 |A |NIL |7,562,219 |D | | ock |00 |c) | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________| ___________________________________________________________________________________________________________________________________ Table II -- Derivative Securitites Acquired, Disposed of, or Beneficially Owned | ___________________________________________________________________________________________________________________________________| 1.Title of Derivative |2.Con |3. |4. |5.Number of De |6.Date Exer|7.Title and Amount |8.Price|9.Number |10.|11.Nature of| Security |version |Transaction rivative Secu |cisable and| of Underlying |of Deri|of Deriva |Dir|Indirect | |or Exer |Date |Code| rities Acqui |Expiration | Securities |vative |tive |ect|Beneficial | |cise Pr | | | red(A) or Dis |Date(Month/| |Secu |Securities |(D)|Ownership | |ice of | | | posed of(D) |Day/Year) | |rity |Benefi |or | | |Deriva | | | |Date |Expir| | |ficially |Ind| | |tive | | | | A/|Exer-|ation| Title and Number | |Owned at |ire| | |Secu | | | | D |cisa-|Date | of Shares | |End of |ct | | |rity | | | Amount | |ble | | | |Year |(I)| | ___________________________________________________________________________________________________________________________________| ___________________________________________________________________________________________________________________________________|
Explanation of Responses: (a) Shares recieved in lieu of payment of debt. (b) The reported transaction is a result of a reverse stock split on a 1 for 100 basis. Reporting of the transaction is not required, however the Registrant has undertaken comprehensive reporting and desires to have all share ownership records consistent. This transaction is reported on a voluntary options basis by the Reporting Person. (c) Shares received in lieu of payment of debt. SIGNATURE OF REPORTING PERSON /s/ HAROLD F. HERRON, PRESIDENT DATE July 25, 2000 -----END PRIVACY-ENHANCED MESSAGE-----