4 1 form4dmytryk033103.txt FORM 4 FOR EDWARD DMYTRYK DATED 3/31/03
---------- FORM 4 ---------- ------------------------- [ ] 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 Estimated average burden hours per response....0.5 ------------------------- 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 ------------------------------------------------------------------------------------------------------------------------------------ 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) Dmytryk, Edward C. [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 CFO 315 Premiere Vista Way Person, if an entity March 31, 2003 -------------------------------- ------------------------------------------ (voluntary) ---------------------------- ------------------------------------ (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 St. Augustine, Florida 32080 Reporting Person ----------------------------------------------------------------------------------------------------------------------------------- (City) (State) (Zip) TABLE 1 -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ----------------------------------------------------------------------------------------------------------------------------------- 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) ----------------------------------------------------------------------------------------------------------------------------------- 126,660 D ----------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ 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) ----------------------------------------------------------------------------------------------------------------------------------- 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) ------------------------------------------------------------------------------------------------------------------------------------ 11/14/ 12/31/ Option $1.44 12/31/02 E 25,000 99 02 Common 25,000 $1.44 261,000 D ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: by: /s/ Edward C. Dmytryk 4/2/03 -------------------------------- -------- 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.