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FORM 5
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|_| CHECK THIS BOX IF NO LONGER SUBJECT TO
SECTION 16. FORM 4 OR FORM 5
OBLIGATIONS MAY CONTINUE.
SEE INSTRUCTION 1(B).
|_| FORM 3 HOLDINGS REPORTED
|_| FORM 4 TRANSACTIONS REPORTED.
U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
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
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1. Name and Address of Reporting Person(1) 2. Issuer Name and Ticker or Trading Symbol
O'Brien, Jeremiah NUWAVE TECHNOLOGIES, INC. (WAVE)
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(Last) (First) (Middle) 3. IRS Identification 4. Statement for
Number of Reporting Month/Year
One Passaic Avenue Person, if an entity 12/01
(Voluntary)
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(Street) 5. If Amendment, Date
of Original
Fairfield, NJ 07004 (Month/Year)
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(City) (State) (Zip)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
Director 10% Owner
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X Officer (give Other (specify
--------- title below) ------ below)
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7. Individual or Joint/Group Reporting
(Check applicable line)
X Form filed by One Reporting Person
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Form filed by More Than One Reporting Person
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TABLE 1 - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security 2. Transaction 3. Transaction Code 4. Securities Acquired (A) or 5. Amount of
(Instr. 3) Date (Instr. 8) Disposed of (D) Securities
Beneficially
(Month/Day/ (Instr. 3, 4 and 5) Owned at End of
Year) ---------------------------------- Issuer's Fiscal
Amount (A) or (D) Price Year
(Instr. 3 and 4)
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6. 7. Nature of
Ownership Indirect
Form: Beneficial
Direct (D) Ownership
Or Indirect(I)
(Instr. 4) (Instr. 4)
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TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
FORM 5 (CONTINUED) (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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1. Title of 2. Conversion 3.Transaction 4. Trans- 5. Number of 6. Date Exercisable and 7. Title and
Derivative or Date action Derivative Expiration Date Amount of Underlying
Security Exercise (Month/ Code Securities (Month/Day/ Securities
Price of Day/ Acquired Year)
(Instr. 3) Derivative Year) (A) or (Instr. 3 and 4)
Security (Instr. 8) Disposed
of (D)
(Instr. 3,
4, and 5)
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Date Expiration Title Amount or
Exercisable Date Number of
(A) (D) Shares
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Stock Option $0.610 4/30/01 A 5,000 4/30/01 4/30/11 Common Stock 5,000
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Stock Option $0.790 6/12/01 A 50,000 6/12/01 12/18/01 Common Stock 50,000
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Stock Option $0.790 6/12/01 A 25,000 6/12/01 12/26/01 Common Stock 25,000
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Stock Option $1.160 7/18/01 A 7,143 7/18/01 7/18/11 Common Stock 7,143
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8. Price 9. Number 10. Ownership 11. Nature
of of of of
Deriva- Derivative Derivative Indirect
tive Securities Security: Bene-ficial
Security Beneficially Direct(D) Owner-
Owned at or ship
(Instr. End of Indirect(I)
5) Year (Instr. 4)
(Instr. 4)
(Instr. 4)
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D
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D
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D
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175,000 D
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Explanation of Responses: *Performance Based
/s/ Jeremiah O'Brien 2/12/02
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Signature of Reporting Person (1) Date
(1) International 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 spaced provided is insufficient, see Instruction 6 for procedure.