0001437749-19-000031.txt : 20190102 0001437749-19-000031.hdr.sgml : 20190102 20190102120957 ACCESSION NUMBER: 0001437749-19-000031 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181231 FILED AS OF DATE: 20190102 DATE AS OF CHANGE: 20190102 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Vickers Thomas E CENTRAL INDEX KEY: 0001558977 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-25203 FILM NUMBER: 19500679 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 2018-12-31 0001034592 OMNICOMM SYSTEMS INC OMCM 0001558977 Vickers Thomas E 2101 W. COMMERCIAL BLVD. SUITE 3500 FORT LAUDERDALE FL 33309 1 Chief Financial Officer Common Stock 2018-12-31 4 X 0 1000000 0.25 A 1725000 D Common Stock Warrant 0.25 2018-12-31 4 X 0 1000000 0.03 D 2015-11-23 2019-01-01 Common Stock 1000000 0 D On December 31, 2018, OmniComm Systems Inc. (the "Company") issued 1,000,000 shares of common stock to the Reporting Person upon the cash exercise of Warrants at an exercise price of $0.25. The Reporting Person pledged the 1,000,000 shares as collateral for a term loan. /s/ Thomas E. Vickers 2019-01-02