-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, G7kU8yNQoZexnk1EmCjwQWym9cd3nr8ueTNMeKttKuiz6TRiznXRQB3mUGGIHUxb e5uotjO2Pd13OcaG0cKBRQ== 0001477932-10-000698.txt : 20100930 0001477932-10-000698.hdr.sgml : 20100930 20100930133641 ACCESSION NUMBER: 0001477932-10-000698 CONFORMED SUBMISSION TYPE: 8-A12G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20100930 DATE AS OF CHANGE: 20100930 FILER: COMPANY DATA: COMPANY CONFORMED NAME: OxySure Systems Inc CENTRAL INDEX KEY: 0001413797 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 710960725 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 8-A12G SEC ACT: 1934 Act SEC FILE NUMBER: 000-54137 FILM NUMBER: 101098674 BUSINESS ADDRESS: STREET 1: 10880 JOHN W. ELLIOTT ROAD STREET 2: SUITE 600 CITY: Frisco STATE: TX ZIP: 75034 BUSINESS PHONE: (972) 294-6450 MAIL ADDRESS: STREET 1: 10880 JOHN W. ELLIOTT ROAD STREET 2: SUITE 600 CITY: Frisco STATE: TX ZIP: 75034 8-A12G 1 oxysure_8a.htm FORM 8-A12G oxysure_8a.htm


 
   
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
 
FORM 8-A
 
FOR REGISTRATION OF CERTAIN CLASSES OF
SECURITIES
PURSUANT TO SECTION 12(B) OR (G) OF THE
SECURITIES EXCHANGE ACT OF 1934
OMB APPROVAL 
 
OMB Number: 3235-0056 
 
Expires: October 31, 2011 
 
Estimated average burden
 
hours per response. . . 3.0
 
 
OxySure Systems, Inc.   
(Exact name of registrant as specified in its charter)
 
Delaware    71-0960725
(State of incorporation or organization)
 
(I.R.S. Employer Identification No.)
 
 10880 John W. Elliot Drive, Suite 600, Frisco, Texa    75034
(Address of principal executive offices)
 
(Zip Code)
 
Securities to be registered pursuant to Section 12(b) of the Act:
 
Title of each class
 
Name of each exchange on which
to be so registered
 
each class is to be registered
 _____________________________________________    _______________________________________________
 _____________________________________________    ________________________________________________
 
If this form relates to the registration of a class of securities pursuant to Section 12(b) of the Exchange Act and is effective pursuant to General Instruction A.(c), check the following box. o
 
If this form relates to the registration of a class of securities pursuant to Section 12(g) of the Exchange Act and is effective pursuant to General Instruction A.(d), check the following box. x
 
Securities Act registration statement file number to which this form relates: 333-159402 (if applicable)
 
Securities to be registered pursuant to Section 12(g) of the Act:
 
Common Stock, $0.0004 per share     
(Title of class)
 


 
 

 
INFORMATION REQUIRED IN REGISTRATION STATEMENT
 
Item 1. Description of Registrant’s Securities to be Registered.
 
Incorporated herein by this reference is the description of the securities prepared in compliance with Item 202 of Regulation S-K set forth beneath the caption "Description of Securities," in the prospectus filed by OxySure Systems, Inc. (the "Registrant") with the Securities and Exchange Commission as part of the Registrant's Registration Statement on Form S-1, Registration No. 333-159402 (the "Registration Statement"), and all amendments thereto.

Item 2. Exhibits.

Registrant incorporates herein by this reference, the exhibits from the Registration Statement as follows:

Exhibit No.
 
Description
     
3.1  
Articles of Incorporation, dated January 14, 2004
     
3.2  
Amendment to Articles of Incorporation, dated August 16, 2004
     
3.3  
Amendment to Articles of Incorporation, dated April 7, 2009
     
3.4  
Amendment to Articles of Incorporation, dated May 19, 2009
     
3.5  
Amended and Restated Articles of Incorporation, dated July 7, 2009
     
3.6  
Bylaws, dated January 15, 2004
     
4.1  
Form of Warrant, dated December 2008
     
4.2  
Form of Subscription Agreement for Preferred Stock (March 2005)
     
4.5  
Form of Voting Stock Agreement (February 1, 2004)
     
5.1  
Opinion of Oswald & Yap LLP
     
10.1  
Initial Employment Agreement with Julian T. Ross, dated January 15, 2004 (As Amended July 19, 2004)
     
10.1.1  
Amendment to Initial Employment Agreement with Julian T. Ross, dated August 30, 2008
     
10.1.2  
Second Employment Agreement with Julian T. Ross, dated January 15, 2009
     
10.1.3  
Amendment to Second Employment Agreement with Julian T. Ross, dated January 15, 2009
 
 
2

 
 
10.1.4  
Second Amendment to Second Employment Agreement with Julian T. Ross, dated January 15, 2009
     
10.1.5  
As amended Second Employment Agreement with Julian T. Ross, dated January 15, 2009
     
10.1.6  
Third Amendment to Second Employment Agreement with Julian T. Ross, dated January 15, 2010
     
10.1.7  
As amended Second Employment Agreement with Julian T. Ross, dated January 15, 2010
     
10.2  
Freeman Base Employment Agreement with Scott Freeman, dated September 6, 2005
     
10.2.1  
Freeman Base Employment Agreement First Amendment dated August 31, 2008
     
10.2.2  
Freeman Base Employment Agreement Second Amendment dated January 15, 2009
     
10.2.3  
As amended Freeman Base Employment Agreement dated January 15, 2009
     
10.3  
Frisco Economic Development Corporation Performance Agreement, dated April 3, 2007
     
10.3.1  
Frisco Economic Development Corporation Promissory Note, dated April 3, 2007
     
10.4  
5-Year Lease Agreement with Sinacola Commercial Properties, Limited.  dated March 6, 2007
     
10.4.1  
First Amendment to the 5-Year Lease Agreement with Sinacola Commercial Properties, Limited, dated August 24, 2007
     
10.4.2  
Second Amendment to the 5-Year Lease Agreement with Sinacola Commercial Properties, Limited, dated November 24, 2008
     
10.5  
First Note extended to Agave Resources, LLC, dated April 15, 2008.
     
10.5.1  
Amendment to First Note extended to Agave Resources, LLC, dated February 20, 2009
     
10.6  
“Second Note” extended to JTR Investments, Limited, dated March 1, 2008
     
10.6.1  
Amendment to “Second Note” extended to JTR Investments, Limited, dated February 20, 2009
     
10.7  
“Senior Note” Board Approval, dated November 1, 2008
     
10.7.1  
“Senior Note” extended to JTR Investments, Limited, dated December 31, 2008
 
 
3

 
 
10.7.2  
“Senior Note” extended to JTR Investments, Limited, dated June 30, 2009
     
10.8  
Asset Purchase and Stock Transfer Agreement with JTR Investments, Limited, and affiliates, dated January 15, 2004
     
10.9  
Amended Agreement with IR Services, dated June 22, 2009
     
10.9.1  
Original Agreement with IR Services, Inc., dated April 20, 2009
     
10.9.2  
Cancellation Agreement and Mutual Release with IR Services, dated December 15, 2009
     
10.10  
Voting Stock Option Plan, dated February 1, 2004
     
10.11  
Form of Subcontractor Agreement and Assignment of Intellectual Property
     
10.12  
Form of Lock-up Agreement-Common Stock
     
10.13  
Form of Lock-up Agreement-Preferred Stock
     
10.14  
Department of Transportation Approval Letter, dated October 3, 2008
     
10.15  
Master Lease Agreement with VenCore Solutions, LLC, dated October 26, 2006
     
10.16  
North Texas Enterprise Center for Medical Technology License Agreement, dated April 8, 2004
     
10.16.1  
Amendment of North Texas Enterprise Center for Medical Technology License Agreement, dated August 22, 2004
     
10.16.2  
Amendment of North Texas Enterprise Center for Medical Technology License Agreement, dated May 26, 2005
     
10.17  
CitiCapital Lease 1, dated September 13, 2007
     
10.18  
CitiCapital Lease Agreement 2, dated September 13, 2007
     
10.19  
CitiCapital Lease Agreement 3, dated September 21, 2007
     
10.19.1  
Amendment to CitiCapital Lease Agreement 3, dated October 24, 2007
     
10.20  
Dell Lease 1 Agreement, dated June 5, 2008
     
10.21  
Dell Lease 2 Agreement, dated June 5, 2008
     
10.22  
Dell Lease 3 Agreement, dated December 1, 2008
     
10.23  
Neville Financing Lease Agreement, dated October 17, 2007
 
 
4

 
 
10.24  
NMHG- Yale Lease Agreement, dated December 14, 2007
     
10.25  
Wachovia Lease Agreement, dated December 20, 2007
     
10.26  
Cancellation Agreement and Mutual Release with RKH Capital, dated June 22, 2009
     
10.27  
Sinacola Commercial Properties, Ltd. Letter Agreement, dated December 10, 2009
     
10.28  
Note Agreement with Tony & Judy Alcedo Family Trust, dated December 10, 2009
     
10.29  
Afritex License Agreement dated March 26, 2010
     
10.30  
Afritex Distribution Agreement dated March 26, 2010
     
10.31  
Afritex Note Purchase Agreement dated March 26, 2010
     
14.1  
Code of Ethics
     
23.1  
Consent of Oswald & Yap LLP (included in it opinion set forth in Exhibit 5 hereto)
     
23.2  
Consent of Sam Kan & Company, LLC
     
23.3  
Consent of Sam Kan & Company, LLC
     
99.1  
Form of Subscription Agreement
 
 
5

 
 
SIGNATURE

Pursuant to the requirements of Section 12 of the Securities Exchange Act of 1934, the Registrant has duly caused this Registration Statement to be signed on its behalf by the undersigned, thereto duly authorized.
 
(Registrant) OxySure Systems, Inc  
     
Date  September 20, 2010  
     
By    
  Julian T. Ross, President  
 
 
 
 
 
6

 
 
-----END PRIVACY-ENHANCED MESSAGE-----