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FORM 4
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[ ] Check this box if no longer OMB APPROVAL
subject to Section 16. Form 4 -------------------------
or Form 5 obligations may OMB Number: 3235-0287
continue. See Instruction 1(b). Expires: January 21, 2005
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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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
Section 30(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person* 2. Issuer Name and Ticker Trading Symbol 6. Relationship of Reporting
Person(s) to Issuer
Park City Group, Inc. (PKCY) (Check all applicable)
Fields, Randall K. [X] Director [ ] 10% Owner
----------------------------------------------------------------------------------------------- [X] Officer(give [ ] Other (specify
(Last) (First) (Middle) 3. IRS Identification 4.Statement for Month/Day/Year title below below)
Number of Reporting CEO and President
P.O. Box 5000 Person, if an entity January 21, 2003 --------------------------------
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(Street) 5. If Amendment, Date 7. Individual or Joint/Group Filing
of Original (Check Applicable Line)
(Month/Year) [X] Form filed by One Reporting
Person
[ ] Form filed by More than One
Park City, Utah 84060 Reporting Person
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(City) (State) (Zip) TABLE 1 -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1. Title of Security 2. Trans- 2A. 3. Transaction 4. Securities Acquired(A) 5. Amount of 6.Owner- 7. Nature of
(Instr. 3) action Deemed Code or Disposed of (D) Securities ship Indirect
Date Execution (Instr.8) (Instr. 3,4 and 5) Beneficially Form: Beneficial
Date, if -------------- ------------------------- Owned at End Direct (D) Ownership
any of Month or Indirect
(Month/ (Month/ (A)
Day/ Day/ or
Year) Year) Code V Amount (D) Price (Instr. 3 and 4) (I) (Instr.4) (Instr.4)
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Common Stock 1/19/03 J 7,000,000 A 19,262,900 D
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94,923,100
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Common Stock 1/19/03 J(a) 3,000,000 D 91,923,100 I
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J= Shares issued in consideration for a loan by Riverview Financial Corporation an entity controlled by the Reporting Person.
J(a)= Contributed to an education trust.
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 on 4(b)(v).
Persons who respond to the collection of information contained (Over)
in this form are not required to respond unless the form SEC 1474(9-02)
displays a currently valid OMB control number.
FORM 4 (CONTINUED) Table II -- Derivative Securities Acquired, Disposed of, or Benficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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1.Title of 2.Conver- 3.Trans- 3A. 4.Tansac- 5.Number of 6.Date Exercis- 7.Title and 8.Price 9.Number 10.Owner- 11.Nature
Derivative sion or action Deemed tion Derivative able and Amount of of of Deri- ship of In-
Security Exercise Date Execution Code Securities Expiration Underlying Deri- vative Form of direct
(Instr.3) Price of (Month/ Date, if (Instr.8) Acquired Date Securities vative Secur- Deriva- Bene-
Deri- Day/ any (A) or (Month/Day/ (Intr. 3 Secu- ities tive ficial
vative Year) (Month/ Disposed Year) and 4) rity Benefi- Security: Owner-
Security Day/ of (D) --------------- ------------ (Instr. cially Direct ship
Year) (Instr.3, Amount 5) Owned (D) or (Instr.
4 and 5) or at End Indirect 4)
Date Expir- Title Number of (I)
-------------------- Exer- ation of Month (Instr.4)
Code V (A) (D) cisable Date Shares (Instr.4)
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N/A
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Explanation of Responses:
by: /s/ Randall K. Fields 1/21/03
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Signature of Reporting Person Date
Randall K. Fields
(1) 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 provided is insufficient, see Instruction 6 for procedure.
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 current valid OMB Number.