------------------------------
OMB APPROVAL
------------------------------
OMB Number 3235-0287
Expires: December 31, 2001
Estimated average burden
Hours per response ....... 0.5
------------------------------
U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 4
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
[X] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
See Footnote 2 Below
(Print or Type Responses)
--------------------------------------------------------------------------------
1. Name and Address of Reporting Person*
AW Fields Acquisition, LLC
--------------------------------------------------------------------------------
(Last) (First) (Middle)
1330 Avenue of the Americas, 36th Floor
--------------------------------------------------------------------------------
(Street)
New York New York 10036
--------------------------------------------------------------------------------
(City) (State) (Zip)
--------------------------------------------------------------------------------
2. Issuer Name and Ticker or Trading Symbol
Park City Group, Inc.-- PKCY
--------------------------------------------------------------------------------
3. IRS or Social Security Number of Reporting Person (Voluntary)
N/A
--------------------------------------------------------------------------------
4. Statement for Month/Year
August 2002
--------------------------------------------------------------------------------
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 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
================================================================================
6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
3. Disposed of (D) Securities Form: 7.
Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of
2. Code ------------------------------- Owned at End (D) or Indirect
1. Transaction (Instr. 8) (A) of Month Indirect Beneficial
Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4)
------------------------------------------------------------------------------------------------------------------------------------
Common Stock 08/16/2002 J(1) 8,458,334 (1) (1) 20,125,001 (D)
====================================================================================================================================
(Over)
(Form 4-07/98)
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
================================================================================
10.
9. Owner-
Number ship
of Form
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- 4. Securities Date Securities Price Bene- ity: In-
cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship
Security Secur- Day/ ------- ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
------------------------------------------------------------------------------------------------------------------------------------
Warrant to $0.10 8/16/02 J(2) (2) (2) 6/11/02 3/27/05 Common (2) (2) 20,125,001 (D)
Purchase Stock
Common Stock
====================================================================================================================================
Explanation of Responses:
(1) These shares were issued pursuant to Section 5.4 of the Securities Purchase
Agreement dated March 27, 2002 between the Reporting Person and the Issuer (the
"SPA").
(2) Pursuant to Sections 2 and 9 of the Warrant to Purchase Common Stock (the
"Warrant") issued by the Issuer to the Reporting Person on June 11, 2002
pursuant to the SPA, the exercise price at which the Warrant may be exercised
was reduced from $0.1725 to $0.10, and the number of shares issuable upon
exercise of the Warrant increased from 11,666,667 to 20,125,001.
* 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 provided is insufficient, see Instruction 6 for procedure.
/s/ Stephen D. Weinroth 09/10/02
--------------------------------------------- -----------------------
**Signature of Reporting Person Date
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 OMB Number.