------ -------------------------------------
FORM 4 OMB APPROVAL
------ -------------------------------------
[ ] Check his box if no longer OMB Number 3235-0287
subject to Section 16. Form 4 Expires: September 30, 1998
or Form 5 obligations may Estimated average burden
continue. See Instruction 1(b). hours per response...............0.5
-------------------------------------
U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 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
Grant Gus C
- --------------------------------------------------------------------------------
(Last) (First) (Middle)
7707 E. Acoma Dr. #109
- --------------------------------------------------------------------------------
(Street)
Scottsdale AZ 85260
- --------------------------------------------------------------------------------
(City (State) (Zip)
- --------------------------------------------------------------------------------
2. Issuer Name and Ticker or Trading Symbol
Waterchef, Inc. -- WTER
- --------------------------------------------------------------------------------
3. IRS or Social Security
Number of Reporting
Person (Voluntary)
- --------------------------------------------------------------------------------
4. Statement for Month/Year
November -- 1997
- --------------------------------------------------------------------------------
5. If Amendment,
Date of Original
(Month/Year)
- --------------------------------------------------------------------------------
6. Relationship of Reporting Person to Issuer(check all applicable)
[X] Director [X] 10% Owner
[X] Officer (give title below) [ ] Other (specify below)
President -- CEO
- --------------------------------------------------------------------------------
<PAGE>
<TABLE>
<CAPTION>
Table I -- Non-derivative Securities Acquired, Disposed of, or Beneficially Owned
======================================================================================================
1. Title of 2. Trans- 3. Trans- 4. Securities Acquired (A) 5.Amount of 6. Ownership 7. Nature of
Security action action or Disposed of (D) Securities Form: Indirect
(Instr. 3) Date Code (Instr. 3, 4 and 5) Beneficially Direct(D) Beneficial
(Month/ (Instr.8) (A) or Owned at End or Ownership
Day Year) Code V Amount (D) Price of Month Indirect(I) (Instr.4)
(Instr.3 and 4) (Instr.4)
- ------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C>
Common Stock* 1-29-1997 T 960,000 A .10 3,189,284 D
- ------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
================================================================================
1. Title of 2. Conver- 3. Trans- 4. Transac- 5. Number of Deriv-
Derivative sion or action tion Code ative Securities Ac-
Security Exercise Date (Instr. 8) quired (A) or Dis-
(Instr. 3) Price of (Month/ posed of (D)
Deriv- Day/ (Instr. 3, 4, and 5)
ative Year) -----------------------------------
Security Code V (A) (D)
- --------------------------------------------------------------------------------
Stock Option .20 2-1-1995 A 535,000
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
================================================================================================
6. Date Exer- 7. Title and Amount of 8. Price 9. Number 10.Owner- 11. Nature
cisable and Underlying Securities of of Deriv- ship of
Expiration Date (Instr. 3 and 4) Deriv- ative Form of Indirect
(Month/Day/Year) ative Securities Derivative Beneficial
---------------- ---------------------- Security Beneficially Security Ownership
Date Expira- Amount or (instr.5) Owned at End Direct(D) (Instr.4)
Exer- tion Title Number of of Month or Indirect(I)
cisable Date Shares Instr. 4) (Instr.4)
- ------------------------------------------------------------------------------------------------
2-1-2001 2-1-2001 Common Stock 535,000 N/A 535,000 D
- ------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------
</TABLE>
Explanation of Responses:
* The number of securities reported on table 1 and 2 reported after a 1 for 5
reverse stock split effective June 14, 1993.
/s/ C. Gus Grant 11/11/97
-------------------------- --------------
**Signature of Reporting Person Date
C. Gus Grant
**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.
Page 2
