4 1 0001.txt FORM 4 U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Check this box if no longer OMB APPROVAL subject to Section 16. Form OMB Number: 4 or Form 5 obligations may Expires: continue. See Instruction Estimated average burden 1(b) hours per response...0.5 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 Klever Marketing (KLMK) 6. Relationship of Reporting Person(s) to Issuer Reporting Person* Mills Michael L. (Check all applicable) (Last) (First) (Middle) X Director _____10% Owner ____ Officer (give _____Other title below) (specify below) Interim CFO ------------------------------------------------------------------------------------------------------------------------------------ 3. IRS or Social Security 4. Statement for Individual or Joint / Group Filing Number of Reporting Month/Year (Check Applicable Line) 19936 Promenade Circle Person (Voluntary) X Form Filed by One Reporting Person (Street) January 2001 _____ Form Filed by More than One Reporting Person 5. If Amendment, Date of Riverside CA 92508 5 Original (Month/Year) ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned --------------------------------------------------------------- -------------------------------------------------------------------- 2. Trans- 3. Transac- 4.Securities Acquired (A) or 5. Amount of 6. Ownership 7. Nature of 1. Title of Security action tion Disposed of (D) Securities Form: Indirect (Instr. 3) Date Code (Instr. 3, 4 and 5) Beneficially Direct Beneficial (Instr. 8) Owned at End (D) or Ownership (Month/ of Month Indirect (Instr. 4) Day/ (Instr. 3 and (I) Year) 4) (Instr. 4) ------- ------- ------------------------- -------------- Code V Amount (A)or(D) Price ---------------------------------------- ------- ------- ------ -------- ---------- -------------- ------------------- ------------ Common Stock 28,979 I By Mills ---------------------------------------- ------- ------- ------ -------- ---------- -------------- ------------------- ------------ Family Trust(1) ---------------------------------------- ------- ------- ------ -------- ---------- -------------- ------------------- ------------ Common Stock 23,182 D ---------------------------------------- ------- ------- ------ -------- ---------- -------------- ------------------- ------------ ---------------------------------------- ------- ------- ------ -------- ---------- -------------- ------------------- ------------ ---------------------------------------- ------- ------- ------ -------- ---------- -------------- ------------------- ------------ ---------------------------------------- ------- ------- ------ -------- ---------- -------------- ------------------- ------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) *If the form is filed by more than one reporting person, see Instruction 4(b)(v). SEC 1474
FORM 4 (continued)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ------------------------------------------------------------------------------------------------------------------------------------ 1.Title of 2. 3. 4. 5.Number of 6.Date 7.Title and 8.Price of 9.Number 10. 11.Nature Derivative Conversion Trans- Trans- Derivative Exercisable Amount of Derivative of Ownership of Security or action action Securities and Underlying Security Derivative Form of Indirect (Instr. 3) Exercise Date Code Acquired Expiration Securities (Instr. Securities Derivative Beneficial Price (Month/ (Instr. (A) or Date (Instr. 3 5) Beneficially Security: Ownership of Day/ 8) Disposed of (Month/ and 4) Owned Direct (Instr. Derivative Year) (D) (Instr. Day/Year) at End (D) or 4) Security 3, 4, and 5) of Indirect Month (I) (Instr. (Instr. 4) 4) --------- ----- ----- ----------- ------------------- Code V (A) (D) Date Expir- Title Amount Exer- ation or cisable Date Number of Shares ------------------------------------------------------------------------------------------------------------------------------------ Class A Preferred Common Stock By Olson Stock, Series 1 $-0- 1/3/01 P 37,879 1/3/01 n/a par value 378,790 $6.60 3,767.9 I farms, Inc. $0.01 per share (2) ------------------------------------------------------------------------------------------------------------------------------------ Stock Option $1.00 1/26/01 A 100,000 1/26/02 1/26/04 Common Stock $1.00 112,000 D par value $0.01 per share ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses: Includes (1)28,979 shares of common stock, par value $0.01 per share ("Shares") held by Mr. Mills as sole trustee of Mills Family Trust, of which his wife is sole beneficiary, as to all of which Shares Mr. Mills disclaims beneficial ownership; and (2) 37,879 newly acquired shares of Class A Preferred Stock, Series 1 ("Preferres Shares") (convertible into 378,790 Shares) held by Olson Farms, Inc., of which Mr. Mills is president as to all of which Mr. Mills disclaims beneficial ownership. Does not include: (a) 41,177 ("Preferred Shares") (convertible into 411,770 Shares) held by Olson Farms, Inc., of which Mr. Mills is president and as to all of which Mr. Mills disclaims beneficial ownership; (b) 759,765 Shares held by Olson Farms, Inc., of which mr. Mills is president as to all of which Mr. Mills disclaims beneficial ownership; (c) 150,000 Shares held by The Olson Foundation, of which Mr. Mills is one of four trustees, as to all of which Mr. Mills disclaims beneficial ownership; (e) 311,834 Shares held by Mr. Mills as sole trustee of the Peter Dean Olson Trust, as to all of which Mr. Mills disclaims beneficial ownership; and (f) 620,132 Shares held by the Estate of Peter Dean Olson, of which Mr. Mills is executor, as to all of which Mr. Mills disclaims beneficial interest. (1) Granted by issuer's board of directors for no consideration. ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). /s/ Michael L. Mills 02/10/01 ----------------------------------- ** Signature of Reporting Person 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. 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.