0001437749-12-001635.txt : 20120223 0001437749-12-001635.hdr.sgml : 20120223 20120222181515 ACCESSION NUMBER: 0001437749-12-001635 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20120223 DATE AS OF CHANGE: 20120222 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: VAN KESTEREN GUUS CENTRAL INDEX KEY: 0001246994 FILING VALUES: FORM TYPE: SC 13G/A MAIL ADDRESS: STREET 1: 2555 DAVIE ROAD 110-B CITY: DAVIE STATE: FL ZIP: 33317 SUBJECT COMPANY: 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 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-62199 FILM NUMBER: 12631555 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 SC 13G/A 1 kersteren_sc13ga4-021412.htm SCHEDULE 13 G/A (AMENDMENT NO. 4) kersteren_sc13ga4-021412.htm
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
 
SCHEDULE 13G
 
UNDER THE SECURITIES EXCHANGE ACT OF 1934
(Amendment No. 4)*
 
 
OMNICOMM SYSTEMS, INC.
(Name of Issuer)
 
 
Common Stock, par value $.001 per share
(Title of Class of Securities)
 
68212 U 10 4
(CUSIP Number)
 
December 31, 2011
(Date of Event Which Requires Filing of This Statement)
 
Check the appropriate box to designate the Rule pursuant to which this Schedule is field:
 
¨ Rule 13d-1(b)
 
x Rule 13d-1(c)
 
¨ Rule 13d-1(d)
 
*
  
The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.
 
The information required on the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
 
 
 
 
 
SCHEDULE 13G
 
 
Cusip No. 68212 U 10 4
 
  
 
Page 2 of 5 Pages
 
  (1) 
NAME OF REPORTING PERSON
I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (entities only)
 
Guus van Kesteren
not applicable
  (2)
CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (See Instructions)
(a)  ¨        (b)  x
 
  (3)
SEC USE ONLY
 
  (4)
CITIZENSHIP OR PLACE OF ORGANIZATION
 
    Holland
NUMBER OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON
WITH
(5) 
SOLE VOTING POWER
 
    5,098,103 shares of Common Stock
(6)
SHARED VOTING POWER
 
    0
(7)
SOLE DISPOSITIVE POWER
 
    5,098,103 shares of Common Stock
(8)
SHARED DISPOSITIVE POWER
 
    0
       (9)
AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
 
    5,098,103
     (10)
CHECK BOX IF AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES  ¨
 
     (11)
PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
 
    5.7%
     (12)
TYPE OF REPORTING PERSON
 
    IN
 
 
 
 
 
SCHEDULE 13G
Cusip No. 68212 U 10 4
  
Page 3 of 5 Pages
 
ATTACHMENT
 
Item 1(a).
Name of Issuer
  
  
  
  
       
 
OmniComm Systems, Inc. (“Issuer”)
  
  
  
  
       
Item 1(b).
Address of Issuer’s Principal Executive Offices
  
  
  
  
       
 
2101 West Commercial Blvd, Suite 3500, Ft. Lauderdale, FL 33309
  
  
  
  
       
Item 2(a) and 2(b).
  
Name of Person Filing and Address of Principal Business Office or, if none, Residence
  
  
  
  
       
 
This Schedule 13G is being filed by Guus van Kesteren, a director of the Issuer, with a principal business office address of 2101 West Commercial Blvd, Suite 3500, Ft. Lauderdale, FL 33309.
  
  
  
  
       
Item 2(c).
Citizenship
  
  
  
  
       
 
Mr. van Kesteren is a citizen of Holland
  
  
  
  
       
Item 2(d).
Title of Class of Securities
  
  
  
  
       
 
Common Stock, $.001 par value per share
  
  
  
  
       
Item 2(e).
CUSIP No.
  
  
  
  
       
 
68212 U 10 4
  
  
  
  
     
Item 3.
If This Statement is Filed Pursuant to Rules 13d-1(b), or 13d-2(b), Check Whether the Person Filing Is a:
  
  
       
 
Not Applicable
  
  
  
  
 
 
 
 
 
SCHEDULE 13G
 
     
Cusip No. 68212 U 10 4
  
Page 4 of 5 Pages
 
                   
Item 4.
Ownership
  
  
  
  
       
 
Provide the following information regarding the aggregate number and percentage of the class of securities of the issuer identified in Item 1.
  
  
  
  
         
 
(a)
  
Amount Beneficially Owned:
  
  
  
  
         
   
  
5,098,103 shares of Common Stock.
  
  
  
  
         
 
(b)
  
Percent of Class:
  
  
  
  
         
   
  
5.7% on the Date of Event Which Requires Filing of this Statement.
  
  
  
  
         
 
(c)
  
Number of shares as to which such person has:
  
  
  
  
           
   
  
(i)
  
Sole power to vote or to direct the vote
  
  
  
  
           
   
  
  
  
5,098,103 shares
  
  
  
  
           
   
  
(ii)
  
Shared power to vote or to direct the vote
  
  
  
  
           
   
  
  
  
0
  
  
  
  
           
   
  
(iii)
  
Sole power to dispose or to direct the disposition of
  
  
  
  
           
   
  
  
  
5,098,103 shares
  
  
  
  
           
   
  
(iv)
  
Shared power to dispose or to direct the disposition of
  
  
  
  
           
   
  
  
  
0
  
  
  
  
     
Item 5.
Ownership of Five Percent or Less of a Class
  
  
     
 
If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more that five percent of the class of securities, check the following ¨
  
  
       
Item 6.
Ownership of More Than Five Percent on Behalf of Another Person
  
  
  
  
       
 
Other than as set forth herein, no other person has the right to receive or the power to direct the receipt of dividends from, or proceeds from the sale of, in excess of 5% of the total outstanding Common Stock.
  
  
  
  
   
Item 7.
Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Holding Company
   
 
Not Applicable.
       
Item 8.
Identification and Classification of Members of the Group
  
  
  
  
       
 
Not Applicable.
  
  
  
  
       
Item 9.
Notice of Dissolution of Group
  
  
  
  
       
 
Not Applicable.
  
  
  
  
       
Item 10.
Certifications
  
  
  
  
 
 
 
 
 
SCHEDULE 13G
 
Cusip No. 68212 U 10 4
  
Page 5 of 5 Pages


       
 
  
By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect.
  
  
  
 
SIGNATURE
 
After reasonable inquiry and to the best of the undersigned’s knowledge and belief, the undersigned certifies that the information set forth in this statement is true, complete and correct.
 
Date: February 15, 2012    
       
 
 
 /s/ Guus van Kesteren  
   
Guus van Kesteren