U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 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).
[ ] Form 3 Holdings Reported
[ X ] Form 4 Transactions Reported
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1. Name and Address of Reporting Person
McAdam, Gary J.
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(Last) (First) (Middle)
6041 S. Syracuse Way, #307
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(Street)
Englewood, CO 80111
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
International Cavitation Technologies, Inc. - ICTK
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Statement for Month/Year
February 2000
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5. If Amendment, Date of Original (Month/Year)
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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)
President, Industrial Division
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7. Individual or Joint/Group Filing
(Chech applicable line)
[ X ] Form filed by One Reporting Person
[ ] Form filed by More than one Reporting Person
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<PAGE>
<TABLE>
<CAPTION>
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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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) & 4) (Instr.4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C>
By Summer
Common Stock 5/30/98 P 315,000 A $.076 315,000 I Breeze LLC
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By GJM Trading
Common Stock 5/30/98 P 660,000 A $.076 660,000 I Partners Inc.
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Growth Ventures
Common Stock 5/31/99 P 21,500 A $4.00 21,500 I Inc. Profit
Sharing Plan &
Trust
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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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<TABLE>
<CAPTION>
FORM 5 (continued)
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Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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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>
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By Summer
Warrants $1.17 06/01/98 P A Current 06/01/08 Warrants 1,590,000 10,600 159,000 I Breeze LLC
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By GJM
Trading
Warrants $1.17 06/01/98 P A Current 06/01/08 Warrants 1,590,000 10,600 159,000 I Partners Ltd.
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</TABLE>
Explanation of Responses:
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**Signature of Reporting Person Date
** 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.
