0001437749-19-018756.txt : 20190919
0001437749-19-018756.hdr.sgml : 20190919
20190919180652
ACCESSION NUMBER: 0001437749-19-018756
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190918
FILED AS OF DATE: 20190919
DATE AS OF CHANGE: 20190919
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Cohen Adam F.
CENTRAL INDEX KEY: 0001592382
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-25203
FILM NUMBER: 191102383
MAIL ADDRESS:
STREET 1: 2101 WEST COMMERICAL 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
2019-09-18
1
0001034592
OMNICOMM SYSTEMS INC
OMCM
0001592382
Cohen Adam F.
2101 W. COMMERCIAL BLVD.
SUITE 3500
FORT LAUDERDALE
FL
33309
1
Common Stock
1455000
D
Common Stock
2019-09-18
4
D
0
1455000
D
0
D
Incentive Stock Option
0.25
2019-09-18
4
D
0
250000
0.16
D
2022-03-24
Common Stock
250000
0
D
In connection with the merger of Issuer and a subsidiary of Anju Software, Inc. (the "Merger") pursuant to an agreement and plan of merger dated July 15, 2019, all shares of Issuer common stock were canceled and automatically converted into the right to receive $0.41032 per share in cash, without interest and less any applicable withholding taxes.
This option, which is fully vested, was canceled pursuant to the Merger in exchange for a cash payment of $40,081, representing the difference between the exercise price of the option and the merger consideration per share ($0.41032) multiplied by the total number of shares underlying the option, less any applicable withholding taxes.
/s/ Adam F. Cohen
2019-09-19