0001437749-18-016772.txt : 20180910 0001437749-18-016772.hdr.sgml : 20180910 20180910101728 ACCESSION NUMBER: 0001437749-18-016772 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180906 FILED AS OF DATE: 20180910 DATE AS OF CHANGE: 20180910 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: 181061679 MAIL ADDRESS: STREET 1: 2101 WEST COMMERCIAL BLVD. STREET 2: SUITE 3500 CITY: FORT LAUDERDALE STATE: FL ZIP: 33309 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 4 1 rdgdoc.xml FORM 4 X0306 4 2018-09-06 0001034592 OMNICOMM SYSTEMS INC OMCM 0001238906 WIT CORNELIS F 2101 W. COMMERCIAL BLVD. SUITE 3500 FORT LAUDERDALE FL 33309 1 1 1 Executive Chairman Common Stock 2018-09-06 4 A 0 200000 0.33 A 200000 D Common Stock 49908050 I Trust Issued pursuant to the terms and conditions of the 2016 Equity Incentive Plan of OmniComm Systems, Inc. and held in escrow to be released one day prior to the 2019 Annual Stockholder Meeting, subject to continued service and the achievement of performance goals. The holder retains voting rights over all of the shares while in escrow. /s/ Cornelis F. Wit 2018-09-10