0001437749-18-022661.txt : 20181227
0001437749-18-022661.hdr.sgml : 20181227
20181227170223
ACCESSION NUMBER: 0001437749-18-022661
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20181227
FILED AS OF DATE: 20181227
DATE AS OF CHANGE: 20181227
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: 181255200
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
2018-12-27
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
2018-12-27
4
M
0
2000000
0.25
A
51908050
I
Trust
Common Stock
200000
D
Common Stock Warrant
0.25
2018-12-27
4
P
0
2000000
0.03
A
2018-12-27
2019-01-01
Common Stock
2000000
2000000
D
Common Stock Warrant
0.25
2018-12-27
4
M
0
2000000
0.25
D
2018-12-27
2019-01-01
Common Stock
2000000
0
D
On December 27, 2018, OmniCOmm Systems Inc. (the "Company") issued 2,000,000 shares of common stock to Mr. WIt upon the cash exercise of Warrants at an exercise price of $0.25.
/s/ Cornelis F. Wit
2018-12-27