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