FORM 4 |
Check this box if no longer
subject to Section 16.
Form 4 or Form 5
obligations may continue.
See Instruction 1(b).
1. Name and Address of Reporting Person
AXIA Group, Inc. |
2. Issuer Name and Ticker or Trading Symbol
Kelly's Coffee OTC-Bulletin Board Symbol = KLYS |
6. Relationship of Reporting Person to Issuer
__Director
| |
(Last) (First) (Middle) 268 West 400 South, Suite 300 |
3. IRS or Social Security Number of Reporting Person (Voluntary) |
4. Statement for Month/Year August, 2001 |
|
(Street) Salt Lake City, Utah 84101 |
5. If Amendment,
Date of Original (Month/Year) |
||
(City) (State) (Zip) |
1. Title of Security
(Instr. 3) |
2. Transaction
Date
(Month/Day/Year) |
3.
Transaction
Code (Instr. 8) |
4. Securities Acquired (A) or
Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of
Securities
Beneficially
Owned at End
of Month
(Instr. 3 & 4) |
6. Ownership
Form:
Direct (D) or Indirect (I) (Instr. 4) |
7. Nature
of
Indirect
Beneficial
Owner-ship
(Instr. 4) | |||
Code |
V |
Amount |
(A) or
(D) |
Price |
|||||
Common Stock | August 29, 2001 | S | 400,000 | D | $0.02 | 7,223,340* | D & I** | Sub-sidiaries | |
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security |
3. Transaction Date (Month/ Day/Year) |
4. Trans-action Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4,& 5) |
6. Date Exercisable and Expiration Date (Month/ Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Deriv-ative Security (Instr.5) |
9. Number of Derivative Securities Beneficially Owned at End of Month (Instr. 4) |
10.Owner-ship Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature
of
Indirect
Beneficial Owner-ship (Instr. 4) | ||||
|
V |
|
|
Date Exer-cisable |
Expir-ation Date |
|
Amt.. or No. of Shares |
|||||||
Explanation of Responses:
* The Amended filing corrects the number of beneficially owned shares at the end of August, 2001, to include the holdings of all subsidiaries of Axia Group, Inc. ("Axia"), some of which were inadvertently not included in the original filing.
** The 7,243,340 shares held directly and indirectly by Axia consist of 205,000 shares directly owned by Axia; 3,904,720 shares owned by Hudson Consulting Group, Inc., and 3,133,620 shares owned by Oasis International Hotel & Casino, Inc.
/s/ Richard Surber
**Signature of Richard D. Surber, President
Date: February 19, 2002
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.
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