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