U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 5
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
o Check this box if no longer
subject to Section 16.
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
Form 4 or Form 5
obligations may continue.
See Instruction 1(b).
1. Name and Address of Reporting Person:
Richard D. Surber
268 West 400 South - Suite 300
Salt Lake City, Utah 84101
2. Issuer Name and Ticker or Trading Symbol:
Kelly's Coffee Group, Inc.
OTC-Bulletin Board Symbol = KLYS
3. IRS or Social Security Number of Reporting Person (Voluntary):
4. Statement for Month/Year:
1999
5. If Amendment, Date of Original(Month/Year):
6. Relationship of Reporting Person to Issuer (Check all applicable):
_____ Director ___X____10% Owner
_____ Officer(give title below) __X___Other (specify below)
President of Hudson Consulting Group, Inc. ("Hudson), CyberAmerica
Corporation ("Cyber"), Oasis International Hotel & Casino, Inc. ("Oasis"), and
Canton Financial Services Corp. ("Canton")
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>
<CAPTION>
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security 2. Transaction 3. Transaction 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature
(Instr. 3) Date Code or Disposed of (D) Securities Form: of Indirect
(Month/Day/Year) (Instr. 8) (Instr. 3, 4 and 5) Beneficially Direct (D) or Beneficial
Owned at End Indirect (I) Ownership
of Issuer's
Fiscal Year (Instr. 4) (Instr. 4)
(Instr. 3 and 4)
(A) or
Code Amount (D) Price
<S> <C> <C> <C> <C> <C> <C> <C> <C>
Common Stock Aug. 1, 1997 A3 1,150,000 A $0.02* 21,100,070 I Canton Financial
Common Stock Aug. 25, 1997 A3 605,000 A $0.02* 21,100,070 I President Cyber
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Common Stock Aug. 12, 1998 A3 2,000,000 A $0.02* 21,100,070 I Hudson Consulting
Common Stock Sept. 10, 1998 P3 6,500,000 A $0.0262 21,100,070 I Oasis Int'l
Common Stock June 23, 1999 P3 3,842,570 A $0.0104 21,100,070 I Hudson Consulting
Common Stock Aug. 7, 1999 P3 30,000 A $0.04 21,100,070 I Hudson Consulting
Common Stock Nov. 1, 1999 A3 8,000,000 A $0.001* 21,100,070 D
Common Stock Jan. 4, 2000 S4 30,000 D $0.0802 21,100,070 I Hudson Consulting
Common Stock Jan. 4, 2000 S4 91,000 D $0.0809 21,100,070 I Canton Financial
Common Stock Jan. 5, 2000 S4 55,500 D $0.1256 21,100,070 I Canton Financial
Common Stock Jan. 6, 2000 S4 76,500 D $0.1354 21,100,070 I Canton Financial
Common Stock Jan. 7, 2000 S4 41,000 D $0.1205 21,100,070 I Canton Financial
Common Stock Jan. 10, 2000 S4 40,000 D $0.1254 21,100,070 I Canton Financial
Common Stock Jan. 12, 2000 S4 75,000 D $0.0714 21,100,070 I Canton Financial
Common Stock Jan. 13, 2000 S4 45,000 D $0.1254 21,100,070 I Canton Financial
Common Stock Jan. 14, 2000 S4 25,000 D $0.1540 21,100,070 I Canton Financial
Common Stock Jan. 18, 2000 S4 10,000 D $0.1425 21,100,070 I Canton Financial
Common Stock Jan. 19, 2000 S4 50,000 D $0.2118 21,100,070 I Canton Financial
Common Stock Jan. 19, 2000 S4 15,000 D $0.1790 21,100,070 I Canton Financial
Common Stock Jan. 20, 2000 S4 20,000 D $0.1951 21,100,070 I Canton Financial
Common Stock Jan. 21, 2000 S4 20,000 D $0.2507 21,100,070 I Canton Financial
Common Stock Jan. 25, 2000 S4 16,500 D $0.2116 21,100,070 I Canton Financial
Common Stock Feb. 4, 2000 S4 25,000 D $0.1540 21,100,070 I Canton Financial
Common Stock Feb. 10, 2000 S4 10,000 D $0.1716 21,100,070 I Canton Financial
Common Stock Feb. 22, 2000 S4 40,000 D $0.1447 21,100,070 I Canton Financial
Common Stock Feb. 24, 2000 S4 170,000 D $0.1890 21,100,070 I Canton Financial
Common Stock Feb. 25, 2000 S4 225,000 D $0.2618 21,100,070 I Canton Financial
Common Stock Feb. 28, 2000 A4 250,000 A $0.4000* 21,100,070 D
Common Stock Feb. 28, 2000 S4 35,000 D $0.3270 21,100,070 I Canton Financial
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Common Stock Feb. 28, 2000 S4 30,000 D $0.3611 21,100,070 I Canton Financial
Common Stock Feb. 28, 2000 S4 47,000 D $0.3874 21,100,070 I Canton Financial
Common Stock Feb. 29, 2000 S4 30,000 D $0.3725 21,100,070 I Canton Financial
Common Stock Feb. 29, 2000 S4 30,000 D $0.3304 21,100,070 I Canton Financial
Common Stock Feb. 29, 2000 S4 25,000 D $0.3286 21,100,070 I Canton Financial
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly. (Over)
(Print or Type Responses) SEC 1474 (8-92)
<PAGE>
<TABLE>
FORM 4(continued) Table II -- Derivative
Securities Acquired, Disposed of, or
Beneficially Owned (e.g., puts, calls,
warrants, options, convertible
securities)
<CAPTION>
1. Title of 2. Conversion or 3. Transaction 4. Trans- 5. Number of 6. Date 7. Title and 8. Price
Derivative Exercise Price of Date (Month/ action Derivative Exercisable and Amount of of
Security Derivative Day/Year) Code Securities Expiration Date Underlying Deriv-
(Instr. 3) Security (Instr. 8) Acquired (A) or (Month/ Securities ative
Disposed of (D) Day/Year) (Instr. 3 and 4) Security
(Instr. 3, 4,& 5) (Instr.5)
Date Expir- Amt.. or
Code V (A) (D) Exer- ation Title No.of
cisable Date Shares
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
</TABLE>
Table II (continued)
9. Number 10.Owner- 11. Nature
of ship Form of
Derivative of Indirect
Securities Derivative Beneficial
Beneficially Security: Owner-
Owned at Direct (D) ship
End of or Indirect (Instr. 4)
Year (I)
(Instr. 4) (Instr. 4
Explanation of Responses:
*On August 1, 1997, Canton received 1,150,000 shares for consulting services.
On August 25, 1997, Cyber received 605,000 shares for consulting services. On
August 12, 1998, Kelly's Coffee Group, Inc. issued 2,000,000 shares of stock to
Hudson Consulting Group for consulting services. On November 1, 1999, Richard
Surber received 8,000,000 shares for services to the Company. On February 28,
2000 Richard Surber received 250,000 shares for compensation for his efforts as
President of Kelly's.
Pursuant to Section 16(a) of the Securities Exchange Act of 1934, this filing
shall not be deemed an admission that Richard D. Surber is, for purposes of
Section 16 of the Act or otherwise, the beneficial owner of any equity
securities covered by this statement.
** Intentional misstatements or omission of facts constitute Federal Criminal
Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
/s/Richard D. Surber March 28, 2000
------------------------- -------------
**Signature of Richard D. Surber, Individually Date
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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SEC 1474 (8-92)
