-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, OCjgYuF46i3kPZqJHKjZSp2bBDn2X/bz0wCFfYwEw6dDEO50Ob9OAO0Do+zkGq3h sdd2aSR5NqD83nu9ostZUg== 0001181431-08-067882.txt : 20081217 0001181431-08-067882.hdr.sgml : 20081217 20081217162511 ACCESSION NUMBER: 0001181431-08-067882 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20081216 FILED AS OF DATE: 20081217 DATE AS OF CHANGE: 20081217 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: OMNICOMM SYSTEMS INC CENTRAL INDEX KEY: 0001034592 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389] IRS NUMBER: 113349762 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2555 DAVIE ROAD STREET 2: SUITE 110-B CITY: FORT LAUDERDALE STATE: FL ZIP: 33317 BUSINESS PHONE: 954-473-1254 MAIL ADDRESS: STREET 1: 2555 DAVIE ROAD STREET 2: SUITE 110-B CITY: DAVIE STATE: FL ZIP: 33317 FORMER COMPANY: FORMER CONFORMED NAME: CORAL DEVELOPMENT CORP DATE OF NAME CHANGE: 19970225 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: VAN KESTEREN GUUS CENTRAL INDEX KEY: 0001246994 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-25203 FILM NUMBER: 081255344 BUSINESS ADDRESS: BUSINESS PHONE: 9544731254 MAIL ADDRESS: STREET 1: 2555 DAVIE ROAD 110-B CITY: DAVIE STATE: FL ZIP: 33317 4 1 rrd226817.xml FORM 4 X0303 4 2008-12-16 0 0001034592 OMNICOMM SYSTEMS INC OMCM 0001246994 VAN KESTEREN GUUS 1801 CLINT MOORE ROAD SUITE 100 BOCA RATON FL 33487 1 0 0 0 Convertible Debenture 0.5 2008-12-16 4 C 0 300000 0 A 2008-12-16 2010-12-16 Common Stock 300000 1200000 D Common Stock Warrant 0.6 2008-12-16 4 P 0 20000 0 A 2008-12-16 2012-12-16 Common Stock 20000 1220000 D Convertible Debenture 0.5 2008-12-16 4 P 0 20000 0 A 2008-12-16 2010-12-16 Common Stock 20000 1240000 D A convertible debenture was issued on 12/16/2008 as part of a conversion of a Secured Convertible Debenture in the amount of $150,000 that was originally issued on February 29,2008, extended on August 29,2008 and that expired on December 1, 2008. /s/ Guus van Kesteren 2008-12-16 -----END PRIVACY-ENHANCED MESSAGE-----