U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
FORM 5
ANNUAL 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
|_| Check this box if no longer subject of Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
|X| Form 3 Holdings Reported
|X| Form 4 Transactions Reported
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1. Name and Address of Reporting Person*
Clearwater Fund IV Ltd.
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(Last) (First) (Middle)
CITCO Building, Wickhams Cay
P.O. Box 662
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(Street)
Road Town Tortola,
British Virgin Islands
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Monterey Pasta Company - PSTA
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
December 28, 1997
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5. If Amendment, Date of Original (Month/Year)
(1)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
|_| Director |X| 10% Owner
|_| Officer (give title below) |_| Other (specify below)
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7. Individual or Joint/Group Filing (Check Applicable Line)
|X| Form filed by One Reporting Person
|_| Form filed by More than One Reporting Person
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* If the Form is filed by more than one Reporting Person, see Instruction
4(b)(v).
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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<TABLE>
<CAPTION>
5. 6.
4. Amount of Owner-
Security Acquired (A) or Securities ship
Disposed of (D) Beneficially Form: 7.
(Instr. 3, 4 and 5) Owned at End Direct Nature of
2. 3. ----------------------------- of Issuer's (D) or Indirect
1. Transaction Transaction (A) Fiscal Year Indirect Beneficial
Title of Security Date Code Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) (Instr. 8) (D) and 4) (Instr.4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C>
Common Stock 11/13/97 P4(3) 37,037 A $1.6977 D
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Common Stock 12/5/97 S4 33,500 D $1.2744
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Common Stock 12/8/97 C4 108,108 A $1.11 D
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Common Stock 12/8/97 S4 31,000 D $1.656
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Common Stock 12/9/97 S4 16,700 D $1.1062
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Common Stock 12/11/97 S4 19,500 D $1.0129
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Common Stock 12/12/97 S4 17,500 D $0.9396
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Common Stock 12/15/97 S4 26,945 D $0.9087
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Common Stock 12/15/97 S4 23,255 D $0.9088
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Common Stock 12/16/97 S4 72,400 D $0.8323
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Common Stock 12/17/97 S4 2,000 D $0.8450
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Common Stock 12/17/97 S4 67,000 D $0.8828
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Common Stock 12/18/97 C4 4,000,000 A $0.72 D
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Common Stock 12/19/97 P(4) 49,500 A $1.5608 D
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Common Stock 12/22/97 P(4) 53,200 A $1.5382 D
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Common Stock 12/23/97 P(4) 21,000 A $1.5136 D
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Common Stock 12/24/97 P(4) 14,200 A $1.5118 D
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Common Stock 12/26/97 P(4) 30,000 A $1.7019 4,003,245 D
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly
<PAGE>
FORM 5 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
9. 10.
Number Owner-
of ship
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- Securities Date Securities Price Bene- ity: In-
cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date action (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship
Security Secur- Day/ (Instr. ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Series A
Convertible Common
Preferred Stock (5) 3 11/1/96 8/1/98 Stock (5) D3
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Series A
Convertible Common
Preferred Stock (5) 5/21/97 J4(6) 3,000 11/1/96 8/1/98 Stock (5) (6) -0-
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Series A-1
Convertible Common
Preferred Stock (7) 5/21/97 J4(6) 3,000 (7) 3/21/99 Stock (7) (6) D
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Series A-1
Convertible Common
Preferred Stock $1.11 12/8/97 C4 120 (7) 3/21/99 Stock 108,108
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Series A-1
Convertible Common
Preferred Stock $0.72 12/18/97 C4 2,880 (7) 3/21/99 Stock 4,000,000 -0-
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</TABLE>
Explanation of Responses:
(1) This Statement (i) constitutes the Reporting Person's Annual Statement on
Form 5 for the fiscal year ended December 28, 1997 with respect to the
securities of the Issuer, and (ii) amends and restates the information
contained in the Reporting Person's (A) Form 3 filed as of March 23, 1998
and (B) Form 4 filed as of August 7, 1998, each with respect to the
securities of the Issuer.
(2) This report shall not be deemed an admission that the Reporting Person is,
for purposes of Section 16 of the Securities Exchange Act of 1934 (the
"Act"), or otherwise, the beneficial owner of any equity securities
covered by this statement. In addition, this report shall not be deemed an
admission as to the acquisition or disposition of beneficial ownership of
any equity securities covered by this statement for purposes of Section 16
of theAct or otherwise.
(3) Such shares of Common Stock were issued to the Reporting Person by the
Issuer in lieu of the payment by the Issuer of accrued and unpaid
dividends of $50,000 payable pursuant to terms of the Issuer's Series A
Convertible Preferred Stock.
(4) Transaction previously reported by Reporting Person.
(5) Each shares of Series A Convertible Preferred Stock was convertible into
shares of Common Stock, subject to certain adjustments and limitations, at
a conversion rate equal to the lesser of 80% of the average closing price
of Common Stock for the five days immediately preceding conversion and
$9.00.
(6) On May 21, 1997, each share of Series A Convertible Preferred Stock was
exchanged for a share of the Company's Series A-1 Convertible Preferred
Stock.
(7) Each share of Series A-1 Convertible Preferred Stock (the "A-1 Stock") was
convertible into shares of Common Stock, subject to certain adjustments
and limitations, on or after the date on which the Registration Statement
filed by the Issuer with respect to the shares of Common Stock underlying
the A-1 Stock was declared effective until two years from the issuance
date of the A-1 Stock, at a conversion rate equal to the lesser of 80% of
the average closing price of the Common Stock for the five days
immediately preceding conversion and $4.40.
CLEARWATER FUND IV LTD.
/s/ Hans Frederic Heye 2/24/99
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Hans Frederic Heye, Director Date
**Signature of Reporting Person
** 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.