0001437749-15-021273.txt : 20151120
0001437749-15-021273.hdr.sgml : 20151120
20151120143032
ACCESSION NUMBER: 0001437749-15-021273
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20151119
FILED AS OF DATE: 20151120
DATE AS OF CHANGE: 20151120
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-25203
FILM NUMBER: 151246226
MAIL ADDRESS:
STREET 1: 2101 WEST COMMERCIAL BLVD.
STREET 2: SUITE 3500
CITY: FORT LAUDERDALE
STATE: FL
ZIP: 33309
4
1
rdgdoc.xml
FORM 4
X0306
4
2015-11-19
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
Common Stock
2015-11-19
4
A
0
37023517
0.25
A
49828050
D
Common Stock Warrant
0.25
2015-11-19
4
J
0
11440000
0.25
D
2015-01-31
2015-11-19
Common Stock
11440000
0
D
Common Stock Warrant
0.25
2015-11-19
4
J
0
400000
0.25
D
2015-01-31
2015-11-19
Common Stock
400000
6000000
D
Convertible Debt
0.25
2015-11-19
4
M
0
475000
0.25
D
2009-09-30
2015-11-19
Common Stock
1900000
2500000
D
Common Stock Warrant
0.25
2015-11-19
4
J
0
2116000
0.25
D
2015-01-31
2015-11-19
Common Stock
2116000
0
D
Common Stock Warrant
0.25
2015-11-19
4
J
0
3920000
0.25
D
2015-01-31
2015-11-19
Common Stock
3920000
0
D
Common Stock Warrant
0.25
2015-11-19
4
J
0
3800000
0.25
D
2015-01-31
2015-11-19
Common Stock
3800000
0
D
Common Stock Warrant
0.25
2015-11-19
4
J
0
27517
0.25
D
2011-03-31
2015-11-19
Common Stock
27517
0
D
Common Stock Warrant
0.25
2015-11-19
4
J
0
1900000
0.25
D
2009-09-30
2015-11-19
Common Stock
1900000
2500000
D
Common Stock Warrant
0.25
2015-11-19
4
J
0
5760000
0.25
D
2009-12-31
2015-11-19
Common Stock
5760000
0
D
Convertible Debt
0.25
2015-11-19
4
M
0
1440000
0.25
D
2009-12-31
2015-11-19
Common Stock
5760000
0
D
On November 19, 2015, OmniComm Systems, Inc. (the "Company") issued 29,363,517 shares of common stock to Mr. Wit in exchange for the (1) satisfaction in full of an aggregate principal amount of $7,339,000 promissory notes and a convertible debenture, and (2) cancellation and termination of warrants exercisable into an aggregate amount of 29,363,517 shares of the Company's common stock at an exercise price of $.25 per share.
On November 19, 2015, the Company issued 7,660,000 shares of common stock to Cornelis F. Wit, the Chief Executive Officer and Director of the Company ("Mr. Wit"), upon conversion of an aggregate principal amount of $1,915,000 convertible debentures at a conversion price of $.25 per share.
/s/ Cornelis F. Wit
2015-11-20