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 LLC
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(Last) (First) (Middle)
611 Druid Road East, Suite 200
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(Street)
Clearwater, Florida 33756
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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, 1998
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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 3(3) (3) (3)
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Common Stock 3/5/98 S4(5) 2,365,066(5) D(5) $1.1375(5)
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Common Stock 5/1/98 J(6) 1,746,979 A (6) D
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Common Stock 10/19/98 S4 5,000 D $1.4375
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Common Stock 10/20/98 S4 4,000 D $1.4062
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Common Stock 10/21/98 S4 35,000 D $1.358
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Common Stock 10/22/98 S4 46,000 D $1.3633
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Common Stock 10/23/98 S4 6,000 D $1.375
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Common Stock 10/26/98 S4 15,000 D $1.36
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Common Stock 10/27/98 S4 4,000 D $1.36
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Common Stock 10/28/98 S4 10,000 D $1.36
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Common Stock 10/30/98 S4 5,000 D $1.36
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Common Stock 11/2/98 S4 9,000 D $1.3544
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Common Stock 11/4/98 S4 10,000 D $1.33
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Common Stock 11/5/98 S4 34,045 D $1.34
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Common Stock 11/10/98 S4 57,000 D $1.4957
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Common Stock 11/11/98 S4 18,000 D $1.477
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Common Stock 11/12/98 S4 60,000 D $1.4688
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Common Stock 11/13/98 S4 5,000 D $1.46
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Common Stock 11/16/98 S4 8,000 D $1.4516
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Common Stock 11/17/98 S4 3,000 D $1.42 1,483,934 D
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly
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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 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 3, 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) As a result of the Reporting Person's direct acquisition of 71,000 shares
of the Issuer's Common Stock on February 27, 1998, the Reporting Person
became a member of a Section 13D "group" with its wholly-owned subsidiary,
Clearwater Fund IV Ltd., which, as of such date, owned 4,112,045 shares of
the Issuer's Common Stock.
(4) Transaction previously reported by Reporting Person.
(5) Reflects a reduction in the indirect pecuniary interest of the Reporting
Person as a result of the disposition of 2,365,066 shares of the Issuer's
Common Stock by Clearwater Fund IV Ltd., the Reporting Person's
wholly-owned subsidiary.
(6) In May 1998, the Reporting Person received 1,746,979 shares of Common
Stock as a distribution in kind from Clearwater Fund IV, Ltd., the
Reporting Person's wholly-owned subsidiary.
CLEARWATER FUND IV LLC.
/s/ Hans Frederic Heye 2/24/99
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Hans Frederic Heye, Managing Member 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.
