0001437749-13-003381.txt : 20130323
0001437749-13-003381.hdr.sgml : 20130323
20130322170426
ACCESSION NUMBER: 0001437749-13-003381
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20131231
FILED AS OF DATE: 20130322
DATE AS OF CHANGE: 20130322
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: 2101 W COMMERCIAL BLVD.
STREET 2: SUITE 3500
CITY: FORT LAUDERDALE
STATE: FL
ZIP: 33309
BUSINESS PHONE: 954-473-1254
MAIL ADDRESS:
STREET 1: 2101 W COMMERCIAL BLVD.
STREET 2: SUITE 3500
CITY: FORT LAUDERDALE
STATE: FL
ZIP: 33309
FORMER COMPANY:
FORMER CONFORMED NAME: CORAL DEVELOPMENT CORP
DATE OF NAME CHANGE: 19970225
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: WIT CORNELIS F
CENTRAL INDEX KEY: 0001238906
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-25203
FILM NUMBER: 13711977
MAIL ADDRESS:
STREET 1: 2101 WEST COMMERCIAL BLVD.
STREET 2: SUITE 3500
CITY: FORT LAUDERDALE
STATE: FL
ZIP: 33309
5
1
rdgdoc.xml
PRIMARY DOCUMENT
X0306
5
2013-12-31
0
0
0001034592
OMNICOMM SYSTEMS INC
OMCM
0001238906
WIT CORNELIS F
2101 W. COMMERCIAL BLVD.
SUITE 3500
FORT LAUDERDALE
FL
33309
1
1
1
Chief Executive Officer
Convertible Debenture
0.50
2012-01-01
5
P
0
L
250000
0.50
A
2012-01-01
2013-12-16
Common Stock
250000
22650000
D
Common Stock Warrant
0.50
2012-01-01
5
P
0
L
250000
0.50
A
2012-01-01
2013-12-16
Common Stock
250000
40517517
D
On January 1, 2012, the Reporting Person was assigned a Convertible Note of the Issuer dated December 16, 2008 in the amount of $125,000 convertible into 250,000 shares of common stock of the Issuer and warrants convertible into 250,000 shares of common stock of the Issuer at an exercise price of $0.50 with an expiration date of December 16, 2013 from Ronald T. Linares, former Chief Financial Officer of the Issuer. As part of the assignment from Mr. Linares to Mr. Wit, a personal promissory note from Mr. Linares to Mr. Wit in the amount of $100,000 was deemed fully satisfied. In addition, the transaction was part of a business relationship with Mr. Linares involving numerous other transactions unrelated to the Issuer and the Issuer's securities which in the aggregate the Reporting Person is not able to quantify the consideration paid for the securities.
/s/ Cornelis F. Wit
2013-03-21