0001437749-19-000062.txt : 20190102
0001437749-19-000062.hdr.sgml : 20190102
20190102152501
ACCESSION NUMBER: 0001437749-19-000062
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190101
FILED AS OF DATE: 20190102
DATE AS OF CHANGE: 20190102
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: SMITH RANDALL G
CENTRAL INDEX KEY: 0001161696
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-25203
FILM NUMBER: 19501411
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
2019-01-01
0001034592
OMNICOMM SYSTEMS INC
OMCM
0001161696
SMITH RANDALL G
2101 W. COMMERCIAL BLVD.
SUITE 3500
FORT LAUDERDALE
FL
33309
1
1
Executive Vice Chairman
Common Stock
2019-01-01
4
X
0
1800000
0.25
A
4300540
D
Common Stock Warrant
0.25
2019-01-01
4
X
0
1800000
0.03
D
2015-11-23
2019-01-01
Common Stock
1800000
0
D
On January 1, 2019, OmniComm Systems Inc. (the "Company") issued 1,800,000 shares of common stock to the Reporting Person upon the cash exercise of Warrants at an exercise price of $0.25.
/s/ Randall G Smith
2019-01-02